Healthcare Billing & Eligibility Investigator

NYC Health + Hospitals; Hempfield Township (Westmoreland County); On-site; USD 42,000 - 64,000; Full time

Job summary

NYC Health + Hospitals seeks a billing professional to investigate patient eligibility for medical assistance programs and to maximize hospital revenue. You will verify demographic and insurance data, code charges, and process payments while coordinating with Medicaid, Medicare, and other payer sources.

The role emphasizes strong customer service, data accuracy, and effective communication with patients and payers to resolve billing issues and optimize collections.

Qualifications

• Bachelor's degree from an accredited college or university.
• Associate’s degree from an accredited college or university; and completion of an accredited certificate program in medical billing.
• A four-year high school diploma or its educational equivalent; and completion of an accredited certificate program in medical billing; and two years of full-time experience in interviewing, investigation, or a related field, or in customer service.
• A four-year high school diploma or its educational equivalent; and four years of full-time experience, as described above.
• Education and/or experience equivalent to (1)-(4) above. Thirty (30) semester credits may substitute for one year of experience and candidates must have completed an accredited certificate program in medical billing or two years of full-time experience in interviewing/investigations or bookkeeping.

Responsibilities

• Informs patients of healthcare setting rates and conducts in-depth interviews to determine ability to pay.
• Contacts outside agencies, insurance carriers, and employers for information on revenue sources.
• Acts as liaison with social services and home care agencies.
• Refer patients to Medicaid, unemployment, Social Security, and Public Assistance for benefits.
• Process third-party benefits applications including Medicaid and Medicare.
• Review and abstract medical charts for coding and billing forms for computerization.
• Verify patient information and correct codes in the systems.
• Respond to inquiries from patients and third-party payers and resolve disputes.
• Follow up on collections to maximize revenue.

Education

Bachelor's degree

Associate’s degree + certified medical billing program

High school diploma + medical billing certificate

4-year high school diploma + medical billing certificate + 2 years full-time experience

4-year high school diploma + 4 years experience incl. interviewing/investigations

Education/experience equivalent to (1)-(4) with certificate in medical billing

Job description

NYC Health + Hospitals seeks a billing professional to investigate patient eligibility for medical assistance programs and to maximize hospital revenue. You will verify demographic and insurance data, code charges, and process payments while coordinating with Medicaid, Medicare, and other payer sources.

The role emphasizes strong customer service, data accuracy, and effective communication with patients and payers to resolve billing issues and optimize collections.