Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation Medicine, Renal and Mental Health Services.

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.

Work Shifts

9:00AM-5:00PM

Job Description

A member of the revenue cycle process, the Hospital Care Investigator (HCI) for Audits Unit is responsible for timely review, response & follow-up of accounts from HMS & Third-Party Liability audits. The HCI performs related functions in support of the Patient Financial Services operations and other duties, as assigned.

The functions listed below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to the position within the revenue cycle process. The HCI of Patient Accounts Department's Audit Unit:

Duties & Responsibilities

• Conducts investigation & in-depth research to determine eligibility & accuracy of claims received from HMS, financial responsibility for processing bills & payment of hospital bills & accounts receivable follow-up.
• Completes claims in a timely manner for review & processing by insurance payers.
• Utilizes e-Paces, Omni Pro & various payer websites in order to bill & respond to Third Party Liability audits.
• Follows up on Audit accounts, including performing account research & rebilling accounts when appropriate.
• Contacts insurance payers to review claim that have not paid after a reasonable period of time & follows accounts through to resolution.
• Effectively uses financial management system (Epic).
• Documents patient information clearly & completely in financial management system (Epic).
• Reviews & updates patient information & insurance plans prior to submission of claims to ensure accuracy.
• Prepares UB04s for mailing to third party insurances (non-electronic payers).
• Contacts & sends letters to patients for additional information for billing & processing of appeals if needed.
• Prepares response spreadsheet of findings (payments & denials) & submits documentation to HMS & H+H Central Office.
• Prepares refunds as per HMS request.
• Scans documents in EDM & On-Base.
• Refers accounts requiring escalation to Senior Hospital Care Investigator in a timely manner.
• Responds to Audits timely & in a manner compliant with payer rules and regulations
• Attends all necessary training sessions to effectively perform the day-to-day functions of the position.
• Performs related duties as assigned by Sr. Hospital Care Investigator.

Minimum Qualifications
1. A baccalaureate degree from an accredited college or university; or
2.An Associate's degree from an accredited college or university; and completion of an accredited certificate program in medical billing; or
3.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
4.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
5.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.

Department Preferences

EQUIPMENT/MACHINES OPERATED:
• Desktop PC; laptop; scanner, all-in-one (printer/scanner/fax)

COMPUTER PROGRAMS/SOFTWARE OPERATED:
• EPIC EMR & Financial Management System
• On-Base & Media Manager for Scanning
• Secure Government/Payer Portals
• MS Excel, Word, Access, PowerPoint
• Adobe Acrobat

PREFERRED SKILLS:
• Strong organization & communication skills (written & oral);
• Computer literate;
• Prior experience in a healthcare setting along with patient financial services experience;
• Prior experience working within electronic medical record & financial management system in hospital or physician office setting preferred but not required.

KNOWLEDGEABLE IN:
• Basics of Hospital's Revenue Cycle & general principles of hospital's billing & follow-up requirements.

If you wish to apply for this position, please apply online at employment.nychhc.org.

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