Verification Specialist

Regular Full-Time

Location:

901 West Main Street, Freehold, NJ

Job Category:

CentraState Medical Center

Primary Shift:

Day

Work Schedule:

9A-5P

Days and Hours:

Monday to Friday

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Overview

Registers and schedules patients according to established procedures. Pre-screens patients to determine accurate financial responsibilities. Secures all legal consents and insurance information, verifies insurance coverage, and obtains pre-certification authorization, as appropriate.

Responsibilities

  • Uses critical thinking skills to verify each account in hospital registration system following all departmental procedures to ensure compliance with state and federal regulations.
  • Responsible to obtain and determine the coordination of benefits and accurately inputs into computer software system following industry standards and departmental procedure.
  • Clearly documents in computer system all communication with patients, family members, insurance companies and physicians. Documents any exceptions to standard procedure.
  • Is a strong decision maker in relation to completing quality checks and the review of each account for correct information.
  • Coordinates with insurance companies, patients, physicians, and/or employers to verify coverage, to notify of services and to obtain precert and/or referral requirements.
  • Coordinates discussions with physicians and physician’s staff and patients on status of account and actions that will be taken. Clearly documents all communications.
  • Possesses communication skills, knowledge and professionalism to foster a discussion with patients and/or families on patient’s financial responsibilities and clearly documents all communication.
  • Possess tertiary clinical knowledge to understand pocedure/surgery/admission that is being verified.
  • Utilizes TRACE to record all outgoing verification calls to insurance companies.
  • Utilizes and trains staff on all available insurance company specific websites to ensure accurate and timely confirmation of coverage and on-line authorization where applicable and is responsible for maintaining security access.
  • Utilizes TRACE to retain all information from insurance website utilizing PIXCERT software.
  • Maximizes all available resources to accurately verify the account, including prior patient accounts, charity care list, Medicaid eligibility criteria, and Medicare Secondary Payor information. Clearly documents all findings and communications in registration and/or billing systems.
  • Investigates all self pay, workman compensation, no fault and secondary coverage utilizing birthday rule, patient vs spouse vs parents benefits, marital status, diagnosis, occurrence codes, cpt codes, employment status, age, dependency, physicians, families and employers. Clearly documents all findings and communications in registration and/or billing systems.
  • 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.
  • Reverify denied accounts, review with supervisor for resolution. Resubmit or complete process for appeal.
Qualifications

  • High School Diploma or Equivalent required
  • Previous hospital experience in scheduling, registration or billing preferred
  • Knowledge of medical terminology and strong customer service skills
  • Must be highly organized and capable of multi tasking
About Us

CentraState Healthcare System, a partner of Atlantic Health System, is a fully accredited, not-for-profit, community-based health system that provides comprehensive health services in the central New Jersey region. In addition to offering a full range of leading-edge diagnostic and treatment options, CentraState serves as a valuable health partner focused on the latest ways to prevent disease, promote healthy behaviors, and help people of all ages live life well. Based in Freehold, CentraState is comprised of a 284-bed acute-care hospital, a vibrant health and wellness campus, three award-winning senior living communities, a charitable foundation, and convenient satellite health pavilions offering primary care and specialty physician practices, along with access to outpatient services, such as lab and physical therapy. The system also offers a family medicine residency and geriatric fellowship training program in affiliation with Rutgers Robert Wood Johnson Medical School. Among its many honors and accreditations, CentraState is one of less than two percent of hospitals nationwide to earn Magnet® designation for nursing excellence four times and was designated a Great Place to Work-Certified™ Company by Great Place to Work® for the second consecutive year.

 

When you bring your talent to CentraState, you are joining a trailblazing healthcare facility, committed to providing high-quality, patient-focused care. Join us in making incredible strides in health care, and making a difference in our community. We believe in enriching the lives of our employees through work/life balance initiatives, tuition assistance, career advancement opportunities and much more.

 

Find out why our employees love their jobs and being part of the CentraState family!

 

What We Offer:

  • Highly competitive compensation
  • Excellent benefits package and rewards program
  • 403(b) retirement plan with company match
  • 401(a) retirement plan with employer contribution
  • Life Insurance 
  • Tuition Reimbursement Program
  • Profit Sharing Program
  • Growth Opportunity and Workforce Development Initiatives
  • Continuing Education / Onsite Training
  • A warm, welcoming company culture based upon mutual respect and a collaborative goal of providing excellent patient care
  • Concierge Services with Work & Family Benefits
  • Magnet recognized healthcare facility
Commitment to Diversity and Inclusion

At CentraState Healthcare System, 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.

 

CentraState Healthcare System, is an equal employment opportunity employer and federal contractor or subcontractor and, therefore, abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, gender identity or expression, sexual or affectional orientation, national origin or nationality, citizenship status, disability, age, genetics, protected veteran status, ancestry, marital status.