Hospital Care Investigator
1 month ago
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
TOUR II (9am - 5pm)
Purpose of Position:
Under direct supervision, conduct investigations to take the necessary actions to bill and collect for services; verify, modify and code demographic and insurance data obtained from source documents, and accurately enter such data into computerized system(s) ensuring compliance with payer rules and regulations; perform billing and collection functions; complete and/or review paper and electronic claims for proper and timely submission to insurance carriers; follow up with insurance carriers, employers and/or patients for prompt payments; monitor and track denials and underpayments received from insurance carriers; complete non-clinical appeals when necessary; escalate accounts to supervisor in a timely manner in order to obtain maximization of a hospital's or health care facility's revenue.
Areas of Responsibilities:
A member of the revenue cycle process, the Follow-up Representative 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 Follow-up Representative is responsible for knowing current rules and regulations for each payer. Major responsibilities include account research, potentially re-billing accounts and seeing accounts with pending balances through to resolution.
Summary of Duties and Responsibilities:
The identification of essential functions below is 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.
• 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 resolve outstanding payer balances
• 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.
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
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