Verification Specialist

CentraState Healthcare System•Freehold, NJ

2d•$18 - $29•Onsite

About The Position

CentraState Medical Center is currently seeking a Verification Specialist to support its Physical Therapy department. The role involves registering and scheduling patients in accordance with established procedures, pre-screening patients to determine accurate financial responsibilities, securing all legal consents and insurance information, verifying insurance coverage, and obtaining pre-certification authorization as appropriate.

Requirements

High school diploma or equivalent required.
Hospital experience in registration or billing preferred.
Knowledge of medical terminology.
Strong customer service skills.

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, and industry standards.
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.
Maintains productivity within guidelines set by department.

Benefits

Medical, Dental, Vision, Prescription Coverage (30 hours per week or above for full-time and part-time team members)
Life & AD&D Insurance
Long-Term Disability (with options to supplement)
403(b) Retirement Plan with employer match
401(a) Retirement Plan with employer contribution
PTO
Tuition Reimbursement
Well-Being Rewards
Employee Assistance Program (EAP)
Fertility Coverage, Healthy Pregnancy Program
Flexible Spending & Commuter Accounts
Pet, Home & Auto, Identity Theft and Legal Insurance
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