Hosp Care Investigator

NYC Health + Hospitals/Gouverneur is a 295-bed Skilled Nursing Facility (SNF) with a 5-Star CMS Quality Rating located in Manhattan's Lower East Side neighborhood. Gouverneur offers enhanced, cutting edge healthcare services in a state-of-the-art space. It provides 24-hour care for individuals in need of sub-acute care, long-term care or hospice care which include services like physical therapy, occupational therapy, speech and vocational rehabilitation. Gouverneur is an academic affiliate of NYU School of Medicine and Rusk Institute of Rehabilitation Medicine.

From more than 600 Nursing Homes, Gouverneur ranks #7 in Newsweek's Best Nursing Homes in New York2024; and also received high-performance ratings for Long-term Care and Short-term Rehabilitation from U.S. News & World Report's Best Nursing Homes in America 2024.

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.

Job Description

We seek a detail-oriented, experienced nursing home Biller to join our healthcare team. The ideal candidate will be responsible for accurately processing Managed Care, Medicare, and Medicaid claims submission and cash posting. This role requires a strong understanding of medical insurance, Medicare and Medicaid regulations, and revenue cycle management to ensure timely reimbursement and financial stability for the facility.

Duties & Responsibilities

• Verify patient insurance coverage, eligibility, and benefits to determine patient responsibility and billing requirements.
• Prepare and submit insurance claims electronically or by mail, ensuring compliance with payer requirements and timely submission deadlines.
• Prepare and submit Medicare and Medicaid claims timely and accurate.
• Follow up on outstanding claims, denials, and rejections, resolving billing discrepancies and resubmitting claims as necessary.
• Submitting appeals to insurance companies.
• Navigate provider portals for claims review and appeal submission.
• Collaborate with healthcare providers and clinical staff to ensure accurate documentation and coding practices to support claim submission.
• Provide support and guidance to patients regarding billing inquiries, payment options, and financial assistance programs.
• Responsible for private collection.
• Coordinates with the Case Management Team for missing and Continuing Authorizations.
• Review Aging reports, attend the monthly Aging meeting, and provide updates on Open Accounts.
• Post daily cash receipts, including insurance, private, NAMI, and other miscellaneous cash, and reconcile the bank statements.
• Assists in other responsibilities assigned by the Manager.
• Maintain confidentiality of patient information and adhere to HIPAA guidelines and regulations.

Minimum Qualifications

• An Associate degree from an accredited college or university, or a high school graduate or a High School Equivalency Diploma; and four (4) years of experience in medical billing. Proficiency in Microsoft Excel, Word, and Outlook.
• Demonstrates commitment and accountability to be culturally sensitive to internal and external customers.
• Knowledge of e-paces and insurance portals is a plus.

If you wish to apply for this position, please apply online by clicking the "Apply Now" button

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