Hospital Care Investigator

NYC Health + Hospitals; New York (NY); Presencial; USD 52.000 - 76.000; Tempo integral

Resumo da vaga

Harlem Hospital Center in New York is seeking a Billing and Collections Specialist to determine eligibility for medical assistance programs and to manage billing for hospital charges.

Under supervision, you will verify demographic and insurance data, code information, bill third-party claims, pursue revenue, and act as a liaison with patients and insurers. The role demands strong communication and attention to detail in a high-volume hospital setting.

Qualificações

• Bachelor’s degree or higher from an accredited college or university.
• Associate’s degree plus an accredited medical billing certificate.
• High school diploma plus a medical billing certificate and 2 years related experience.
• Four-year high school diploma and 4 years related experience, with 2 in interviewing/investigation or billing.
• Equivalent combinations of education and experience with required certificate in medical billing.

Responsabilidades

• Determine patients' ability to pay and inform them of hospital rates.
• Contact outside agencies and insurers for revenue information.
• Refer patients to Medicaid, Medicare, or other benefits as needed.
• Process enrollment for third-party billing and maximize revenue.
• Review charts and code information for billing and claims.
• Verify and update patient data in the system.
• Handle complex inquiries from patients and payers and resolve disputes.
• Follow up on collections to maximize revenue.

Conhecimentos

Interviewing

Investigation

Customer service

Billing knowledge

Medical billing

Formação

Bachelor's degree

Associate’s degree + medical billing certificate

High school diploma + medical billing certificate

Two years experience in interviewing/investigation or related field

Four years experience incl. two in interviewing/investigations

Descrição da vaga

Marketing Statement

Harlem Hospital Center has been a bedrock of the Harlem community since 1887. The hospital provides a wide range of medical, surgical, diagnostic, therapeutic and family support services to the residents of Central Harlem, West Harlem, Washington Heights and Inwood. Harlem is the largest hospital in the area, capable of treating the most seriously ill. Harlem provides over 90 specialized ambulatory care services, dentistry and oral surgery, behavioral health services, and community substance abuse treatment.

Marketing Statement

Harlem Hospital Center has been a bedrock of the Harlem community since 1887. The hospital provides a wide range of medical, surgical, diagnostic, therapeutic and family support services to the residents of Central Harlem, West Harlem, Washington Heights and Inwood. Harlem is the largest hospital in the area, capable of treating the most seriously ill. Harlem provides over 90 specialized ambulatory care services, dentistry and oral surgery, behavioral health services, and community substance abuse treatment.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Duties & Responsibilities

Purpose of Position:

Under direct supervision, conducts investigations in a health care setting to determine the eligibility of applicants for medical assistance payment programs or the ability of patients and their legally responsible relatives to pay for hospital or health care charges and takes the necessary actions to bill and collect for these services; explores alternative sources for payment for health care setting services rendered; codes, verifies and modifies demographic and insurance data obtained from source documents and enters such data into a computerized system; performs billings and collections functions in order to obtain maximization of health care setting’s revenue; all personnel perform related work.

Examples Of Typical Tasks

• Informs patient of health care setting rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the health care setting, during field investigations, and/or by telephone to determine patients’ and/or legally responsible relatives’ ability to pay for services rendered.
• Contacts outside agencies, organizations, insurance carriers and employers to obtain necessary information about potential sources of revenue.
• Acts as a liaison with social services and home care agencies.
• Refers patients to various health care setting departments and outside agencies, such as Medicaid, New York State Unemployment Insurance, Social Security and Public Assistance for possible benefits.
• Facilities processing of patients’ applications for third-party benefits, including but not limited to Medicaid and Medicare.
• Reviews and abstracts medical charts to obtain pertinent information for accurately coding and completing third- party billing forms, indicating treatment given, discharge diagnoses and overall patient information for computerization purposes.
• Reviews patient account records to ensure patients are properly billed; verifies and corrects patient bills and codes information for computerized system.
• Verifies accuracy of patient information stored in computer and codes changes and modifications, as necessary.
• Responds to complex inquiries from patients and third-party payers and resolves disputes concerning bills submitted for payment.
• Follows-up on collections to ensure maximization of revenue.

Minimum Qualifications

• A baccalaureate degree from an accredited college or university; or
• An Associate’s degree from an accredited college or university; and completion of an accredited certificate program in medical billing; or
• A four-year high school diploma or its educational equivalent; and completion of an accredited certificate program in medical billing; and two (2) years of full-time experience in interviewing, investigation, or a related field, such as credit and collection follow-up or bookkeeping, or as a customer service representative providing comprehensive customer service entailing the dispensing of information or listening to and resolving customer’s concerns, problems and complaints or troubleshooting; or
• A four-year high school diploma or its educational equivalent; and four (4) years of full-time experience, as described in #3 above, at least two years of which must have been in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping; or
• Education and/or experience which is equivalent to (1), (2), (3) or (4) above. College education may be substituted for experience on the basis that thirty (30) semester credits are equivalent to one (1) year of experience and candidates must have completed an accredited certificate program in medical billing or have at least two years of full-time experience in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping. In addition, all candidates must have at least a four-year high school diploma or its educational equivalent.