What are the responsibilities and job description for the AWC - Verification Specialist - FMS position at enj?
Verification Specialist – Jamesburg, NJ (Hybrid)
Shift: Full-Time, various weekly schedule options available:
- Option 1: Monday to Friday, 8:30 AM – 4:30 PM
- Option 2: Thursday to Monday, 8:30 AM – 4:30 PM
Join Our Team – Make a Difference!
Are you passionate about supporting individuals with developmental disabilities and mental health challenges? Join a dynamic team dedicated to improving lives!
About Us and Our Program:
Easterseals, a national nonprofit, has supported individuals with disabilities for over 50 years. Its Agency with Choice program offers an alternative to traditional provider-managed services, empowering participants to manage their support and services with increased choice and authority.
What You’ll Do:
The Verification Specialist will review and analyze case notes to ensure that the services rendered comply with the program participant’s Plan of Care (POC) for Medicaid billing purposes.
Key responsibilities include:
- Research, investigate, and follow-up with the self-directed employees (SDEs) and Program Participants to effectively resolve discrepancies impacting payments to providers and Medicaid billing.
- Reviews SDE case notes and timesheets to ensure accuracy of information, continuity of care, and appropriateness & timeliness of documentation in accordance with Medicaid’s billing requirements.
- Contacts SDEs when notes are not consistent with the set requirements, standards, and POC.
- Collaborates/Communicates with Verification Team Lead on any information received from Authorized Representatives, Support Coordinators, or SDEs regarding the participant’s care or needs.
- Researches, investigates, and follows-up with program participants to effectively resolve any discrepancies, which may have an impact on payments made to providers as well as Medicaid billings.
- Coordinates referrals for prior authorization and services covered.
Who You Are:
- Education: Associate’s degree preferred.
- Experience: 1 year of previous experience in data/insurance verification.
- Requirements: Proficient in Medicaid billing procedures, intermediate MS Office skills, and strong typing abilities with experience in transcribing notes for data entry into applications and systems.
- Skills: Strong verbal communication skills (Spanish preferred), exceptional customer service and relationship management abilities, detail-oriented, and highly skilled in time management.
What We Offer:
- Competitive Pay & Benefits – Including Medical, Dental, Vision, and Flexible Spending Accounts
- Employer-Paid Coverage – Life, AD&D, and Long-Term Disability Insurance
- Retirement Savings – 403(b) Plan with Employer Match
- Generous Time Off – Paid Time Off, Holidays, Medical Leave, and PTO Buy-Back options
- Convenience & Support – Direct Deposit, Payroll Cards, Mileage Reimbursement, and Employee Assistance Program
- Wellness & Recognition – Wellness Program, Referral Bonuses, and a Recognition Program
- Training & Development – Paid Orientation and Ongoing Training
Easterseals NJ provides a comprehensive benefits package. For full details, visit www.enjbenefits.com.
Easterseals Is An Equal Opportunity Employer
As one of our core values, we strive to provide equal opportunity to all of our employees without regard to their age, gender, religion, race, color, national origin, marital status, sexual orientation, or disability which is unrelated to the ability to perform essential job functions, unfavorable military discharge (except dishonorable), veteran status, marital status, parental status, genetic information, source of income or other legally protected categories in accordance with applicable law with regard to receipt of services, appointment or election to voluntary office or hiring for, assignment to, or promotion in staff positions.
