Hospital Care Investigator

1 week ago

Jamaica, United States Equiliem Full time
Client Summary:
The nation's largest municipal health care delivery system in the United States dedicated to providing the highest quality health care services to all New Yorkers with compassion, dignity and respect, and regardless of immigration status or ability to pay.

Summary of Need:
1. Verification of insurance eligibility and benefits for all patients requesting Advanced Imaging Services.
2. Conduct comprehensive System Checks for the uninsured population and/or when no insurance has been identified. This also includes telephone interviews with patients when all other tools and/or options has been exhausted.
3. Ensure appropriate notation has been documented in Epic. This also includes any other systems associated with processing Advanced Imaging procedures.
4. Submit online authorization request to Evicore\Insurance Companies for patients scheduled for Imaging Services.
5. Financially clear patients scheduled for Imaging Services in Epic when the authorization has been received and approved.
6. Communicate any issues that may arise after the request has been submitted with the Ordering Provider and Attending via e-mail. This will include request for additional notes, denials, and any other correspondence received from the initial request.
7. Facilitate Public Health Insurance screening and enrollment via the NY State of Health for the uninsured populations requesting Imaging Services.
8. Accurately update and revise Demographic, Biographic, and Insurance information in our Patient Accounting/Revenue Cycle Systems on all active accounts to reflect the most current data.
9. Provide end of the day daily productivity reports to the Advanced Imaging Unit managers which would include status updates on all cases assigned daily. This should include all cases that have been submitted, approved, and denied.
10. Inform patients or their representatives via mail and/or telephone of their scheduled appointment date, time, and location.
11. Conducts patient interviews and/or pre-screening process to obtain identifying/qualifying Demographic, Biographic and Insurance information to complete the New Patient Registration process.
12. Demonstrate the ability to be flexible, organized, and function efficiently in a fast paced environment.
13. Follow and adhere to all steps in the Advanced Imaging workflow guidelines.
14. Other assignments and special projects as deemed necessary and or appropriate by the Department.

Qualifications/Requirements:
Baccalaureate Degree from an accredited college or university; or, High School diploma or its educational equivalent approved by the State Department of Education or a recognized accrediting organization, and four (4) years of full-time experience in interviewing, investigation, or a related field, such as credit and collection follow-up or bookkeeping; or, Education and/or experience which is equivalent to "1" or "2" 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 High School diploma or its educational equivalent approved by the State Department of Education or a recognized accrediting organization

Knowledge, Skills, Abilities:
  • Complete both paper and electronic claims, in a timely manner.
  • Effectively use computer systems Document patient information clearly and completely in systems.
  • Interact with other departments to complete billing on accounts.
  • Process rejections, denials, and other correspondence in a timely manner.
  • Process pre authorizations, documenting responses in the system and following up as needed
  • Audit patient accounts for accuracy..
  • Apply adjustments as needed.
  • Provide billing costumer service and ensure that conversations are documented accurately.
  • Processing statements and entering information into database; and reviewing past due bills and following up on past due accounts.
  • Generate Patient Balance Aging report and Insurance Aging report and following with patients and insurances accordingly.
  • Arrange payment schedules with patients. 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 Manager or Supervisor.

Additional Remarks:
  • Experience in Financial Counseling
  • Experience in, In & Out Patient
  • Experience in Financial Screening
  • Experience in Financial Clearance
  • Experience in Portal Enrollment-CACs certified application counselors & or marketplace facilitated enrollers.

Shift/Schedule:
  • 5x8, 35 hours per week with 1 hour of unpaid lunch
  • Must be available for alternating weekends, 7am-3pm or 3pm-11pm

Contract Length: 8 weeks

Equiliem specializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum. Our projects range from short to long term local and travel assignments. Equiliem has been recognized as a certified small business enterprise. In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 5 years running by our employees and client partners.
Benefits offered to our workers include the following:
  • Medical Insurance
  • Vision & Dental insurance
  • Life Insurance
  • 401K
  • Commuter Benefits
  • Employee Discounts & Rewards
  • Payroll Payment Options
Equiliem (www.equiliem.com) believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.
Across the U.S., leading companies in healthcare, government, light industrial manufacturing, professional services, and energy rely on us for their workforce solutions. Our recruiting and HR services include contract and direct hire staffing, Payrolling/EOR, and Independent Contractor Compliance.
For over 50 years, we've helped shape our industry. Today, we continue to research, ask questions, and constantly enhance the candidate journey and client experience

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