Hospital Care Investigator
4 weeks 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
Position Overview: We are seeking a detail-oriented and experienced Outpatient Clinic Biller to join our healthcare team. The ideal candidate will be responsible for accurately processing medical billing claims for services rendered at our outpatient clinic. This role requires a strong understanding of medical coding, insurance, Medicare and Medicaid regulations, and revenue cycle management to ensure timely reimbursement and financial stability for the clinic.
Duties and Responsibilities
• Review daily patient encounters for accuracy.
• Review billing information in EPIC for discrepancies, correct as necessary, and open tickets.
• 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.
• Assists in other responsibilities assigned by the Manager
Maintain confidentiality of patient information and adhere to HIPAA guidelines and regulations.
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.
If you wish to apply for this position, please apply online by clicking the "Apply Now" button or go to 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
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