Hospital Care Investigator (Provisional)

NYC Health + Hospitals/Coler is an 815-bed nursing facility with a 5-Star CMS Quality Rating located on Roosevelt Island, nestled between Manhattan and Queens. Coler offers long term and subacute care, rehabilitation, and a dedicated memory care unit, comprised of 150 beds featuring an acclaimed music and memory program. The facility features a robust rehabilitation therapy program with expansive gym space for residents. Coler also offers full time physician staff, psychiatry, dental services, an onsite 8-chair dialysis den for hemodialysis, and on-site medical clinics to meet the clinical needs of its residents.

From more than 600 Nursing Homes, Coler ranks #5 in Newsweek's Best Nursing Homes in New York 2024; and also received a 2024 Silver Beacon Award for Memory Care.

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 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

• A Baccalaureate Degree from an accredited college or university; or
• Graduation from a Senior High School or a High School Equivalency Diploma; and
• Four (4) years of experience in interviewing, casework or a related field preferably in a hospital or health care facility setting; or
• A satisfactory equivalent combination of education, training and experience.

Department Preferences

• Minimum of one-year experience in Medicare billing
• Be cognizant of all HIPAA privacy rules to PHI
• Understanding of Federal and State guidelines and all other regulatory requirements for Medicaid billing and collection function
• Knowledge of SNF and LTAC billing and guidelines
• Proficiency in Microsoft Excel, Word, Access, PowerPoint
• Experience in utilizing an electronic medical record system such as Point Click Care

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