Verification Specialist

Regular Full-Time

Location:

901 West Main Street, Freehold, NJ

Job Category:

CentraState Medical Center

Primary Shift:

Day

Work Schedule:

8A-4P

Days and Hours:

Monday-Friday

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Overview

Access services is comprised of Central Scheduling, Outpatient Registration, Admitting, Insurance Verification, Cashier and ED Registration and Reception. Some benchmarks that we are very proud of include:

  • Average wait/registration time is 9 minutes, compared to the national average of 11 minutes
  • 60% of the Access Services are nationally Certified Healthcare Access Associates
  • Outpatient Registration/Scheduling and ED Registration have been in the 90th percentile for the last 10 years

This department works closely as a team as a part of our revenue cycle management division. 

Responsibilities

Verification Specialist

  • Verifies each account in hospital registration system following all departmental procedures to ensure compliance with state and federal regulations.
  • Obtains and determines the coordination of benefits and accurately inputs into computer software.
  • Clearly documents in computer system all communication with patients, family embers, insurance companies and physicians.
  • Completes quality checks and the review of each account for correct information.
  • Re-verifies denied accounts. Resubmits and completes process for appeal.
  • Coordinates with insurance companies, patients, physicians, and/or employers to verify coverage, to notify of services and to obtain pre-certification and/or referral
  • requirements.
  • Coordinates discussions with physicians and physician’s staff and patients on status of account and actions that will be taken.
  • Facilitates discussion with patients and/or families on patient’s financial responsibilities.
  • Investigates all self pay, workers compensation, no fault and secondary coverage.
  • Accurately completes all forms required for a complete verification and sends to
  • appropriate entity, Medicaid requirements to Self Pay Company, 21 day notices to No Fault Carriers, ABN to out patient departments.
  • Works with physician offices to ensure accurate CPT coding for authorizations and maximum payment of contracted rates.

 

Qualifications

Education:

High School Diploma or Equivalent required.

 

Work Experience:

Previous hospital experience in scheduling, registration or billing preferred.

 

Required Knowledge and Skills:

Knowledge of medical terminology and strong customer service skills required.

Physical Demands

Working Conditions:

Normal office environment with possible exposure to infectious patients.

 

Exposure:

Potential for exposure to blood and/or body fluids.

 

Physical Demands:

Sitting – Frequently

Standing/Walking – Occasionally

Kneeling/Stooping – Never

Bending/Climbing – Never

Reaching above shoulder, at waist or below waist – Rarely

Lifting/Pushing or Pulling up to 40 pounds – Occasionally

Lifting/Pushing or Pulling over 40 pounds – Never

Typing/Filing – Frequently 

 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Commitment to Diversity and Inclusion

At CentraState, we welcome and promote the diversity of our employee family!  Each unique person contributes to the overall success of this organization. Our inclusive culture fosters an environment of professionalism and respect for personal differences.

 

Additionally, CentraState Healthcare System prohibits discrimination based on arbitrary consideration of such characteristics such as race, color, religion, national origin, ancestry, gender (including pregnancy), affectual or sexual orientation, gender identity or expression, marital status, age, physical or mental disability or limitation, medical condition, genetic information, or veteran or military status, as well as any other legally protected class of persons and acts, in accordance with applicable State and Federal laws.