Hospital Care Investigator (Provisional)

NYC Health + Hospitals/Gouverneur provides primary and specialty outpatient care through its Diagnostic and Treatment Center (D&TC) and residential care for the elderly and infirmed in its 295-bed Skilled Nursing Facility (SNF). Gouverneur recently completed a $250 million modernization project to offer enhanced, cutting edge healthcare services in a state of the art space. NYC Health + Hospitals/Gouverneur Skilled Nursing Facility provides 24-hour care for individuals in need of short-term, long-term care or hospice care. The facility is rated as a Best Nursing Home by US News and World Report. Post-Acute Care services include physical therapy, occupational therapy, speech and audiology, and vocational rehabilitation.

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

Under direct supervision, conducts investigations to determine ability of patients and their legally responsible relatives to pay hospital charges; explores alternative sources for payments for hospital services rendered; codes, verifies and modifies demographic and insurance data obtained from source documents onto coding forms for later entry into computerized system; performs billings and collections functions in order to obtain maximization of hospital's revenue; performs related work.

• Informs patient of hospital rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the hospital, during field investigations, and/or by telephone to determine patients' and/or legally responsible relatives' ability to pay for services rendered.
• Contacts outside agencies, organizations, insurance carriers and employers to obtain necessary information about potential sources of revenue.
• Acts as liaison with social services and home care agencies.
• Refers patients to various hospital departments and outside agencies, such as Medicaid, New York State Unemployment Insurance, Social Security and Public Assistance for possible benefits.
• Facilities processing of patients' applications for third party benefits, including but not limited to Medicaid and Medicare.
• Reviews and abstracts Medical charts to obtain pertinent information for accurately coding and completing third party billing forms, indicating treatment given, discharge diagnoses and overall patient information for computerization purposes.
• Reviews patient account records to insure patients are properly billed; verifies and corrects patient bills and codes information for computerized system.
• Verifies accuracy of patient information stored in computer and codes changes and modifications, as necessary.
• Responds to complex inquiries from patients and third party payers and resolves disputes concerning bills submitted for payment.
• Follows up on collections to insure maximization of revenue.

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
   1. 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.

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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