Verification Specialist – Jamesburg, NJ (Remote)
Shift: Part-Time, Saturday & Sunday 8 AM to 6 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.