Hospital Care Investigator

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

9:00 A.M - 5:00 P.M

Job Description

A member of the revenue cycle process, the Hospital Care Investigator (HCI) for Medicaid 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. In performing follow-up, the HCI is responsible for contacting insurance payers to review claims that have not paid after a reasonable period of time and follow through to resolution. The HCI is also responsible for knowing current rules and regulations for each payer. Follow-up responsibilities include account research, potentially rebilling accounts and seeing accounts with pending balances through to resolution. HCIs also perform related functions in support of the Patient Financial Services operations and other duties, as assigned.

Duties & Responsibilities
• Complete claims, in a timely manner, for review and processing by the Supervisor.
• Effectively use computer systems.
• Document patient information clearly and completely in the HIS and billing systems.
• Ensure compliance with payer rules and regulations.
• Perform routine follow-up on outstanding insurance balances.
• Review and work appropriate accounts to maximize A/R reduction and minimize write-offs.
• Review payer denials and underpayments and work to resolution.
• Complete claims for review and processing by the Supervisor.
• Interact with other departments to complete billing on accounts.
• 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.
• Perform all other duties, as assigned by the Patient Accounting Manager or Supervisor.

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 a certificate program in medical billing; or
3. A four-year high school diploma or its educational equivalent; and completion of a 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; 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. However, 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

KNOWLEDGEABLE IN:

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

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.

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