Senior Hospital Care Investigator

New York City Health and Hospitals Corporation; New York (NY); On-site; USD 50,000 - 90,000; Full time

Job summary

An established industry player in healthcare is seeking a Senior Hospital Care Investigator to join their Revenue Cycle Services team. This role involves reviewing accounts, preparing claims for submission, and conducting investigations on complex Medicaid cases. The ideal candidate will possess strong investigative skills and a deep understanding of billing processes. With a commitment to patient-centered care, this position offers an opportunity to contribute to the efficiency of healthcare services while ensuring compliance with state and federal regulations. Join a team dedicated to excellence and make a meaningful impact in the healthcare sector.

Benefits

Comprehensive Health Benefits

Retirement Savings and Pension Plans

Loan Forgiveness Programs

Paid Holidays and Vacation

College tuition discounts

Professional development opportunities

Employee discounts programs

Qualifications

• Six months of service as a Hospital Care Investigator.
• Strong understanding of billing processes and regulations.

Responsibilities

• Conduct investigations of complex Medicaid claims and follow-up actions.
• Document and track appeals progress and resolutions.
• Prepare and review reports for billing and follow-up projects.

Skills

Knowledge of Medicaid claiming rules

Investigative skills

Customer service skills

Education

High School Diploma

Associate's Degree in Health Administration

Tools

EPIC

Billing systems

Job description

Lincoln Medical and Mental Health Center is one of New York City’s premier acute care hospitals. Located in Downtown Bronx, Lincoln is a teaching hospital renowned for its Centers of Excellence, and a recognized industry leader in the implementation of state-of-the art medical technology and best practices. Our team of highly trained and caring medical professionals is dedicated to providing the highest quality health care that is safe, compassionate, culturally competent and patient-centered. Comprehensive services are offered in three major primary care areas: Medicine, Pediatrics, and Women’s Health in addition to more than eighty (80) specialty services. At Lincoln, the safety and comfort of our patients is our number one priority.

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.
Visit us at www.nyc.gov/html/hhc/lincoln.

Job Description

SUMMARY OF DUTIES AND RESPONSIBILITIES:

Within the Centralized Billing and Follow-up Unit as a member of the Revenue Cycle Services team. The Senior Hospital Care Investigator (Sr. HCI) for Billing and Follow-Up is responsible for reviewing accounts, correcting claim edits, preparing and completing claims for submission to payers and updating patient accounting systems. The primary caseload for Sr. HCIs within the Centralized Billing and Follow-up Unit will consist of outlier claims requiring follow-up actions.
Follow-up responsibilities include account; research, rebilling, documentation and review until final disposition.

General tasks and responsibilities will include:
• Conduct investigations of more difficult and complex cases requiring knowledge of unique Medicaid claiming rules and guidelines for outlier claims
• Independently respond to vendors and managed care plan requests for itemized bills, medical records and other documentation requests to achieve additional reimbursement
• Work with payors and their vendors to address issues relating to denied charges
• Document and track the progress of appeals and provide detailed updates on the status of cases
• Stay current with guidelines specific to Outlier workflow from Centers for Medicare and Medicaid Services (CMS) and eMedNY
• Scan and upload correspondence documents on cases and ensure status is current
• Participate in team huddles, workgroups and provide feedback and insights on work processes
• Prepare and review reports as assigned
• Participate in billing and follow-up special projects for revenue improvement
• Conduct timely follow-up with payers on unresolved issues
• Use workqueue monitoring and dashboard tools to ensure assigned claims are processed efficiently and with highest value claims receiving required attention.
• Interpret H+H, city, state & federal rules & regulations and apply appropriately to claims
• Adhere to timely billing and reporting guidelines
• Document patient information clearly and completely in the billing system
• Review payer denials and underpayments and work towards resolution
• Refer accounts requiring escalation to Supervisor in a timely manner
• Attend all necessary training sessions to effectively perform the day-to-day functions of the position
• Accurately update and revise demographic, biographic, and insurance information in EPIC
• Perform customer service and/or billing inquires for patients presenting with account issues, billing issues, etc.
• Perform all other duties, as assigned by the Patient Accounting Manager or Supervisor.

Minimum Qualifications

Six months of service as a Hospital Care Investigator.

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button or forward your resume, noting the above Job ID #, to:

NYC Health and Hospitals offers a competitive benefits package that includes:

Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Loan Forgiveness Programs for eligible employees
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
College tuition discounts and professional development opportunities
Multiple employee discounts programs