Hospital Care Investigator
4 weeks ago
Job Description: Hospital Care Investigator
Hospital Care Investigators under direct supervision, conduct investigations in a health care setting to determine the eligibility of applicants for medical assistance payment programs or the ability of patients and their legally responsible relatives to pay for hospital or health care charges and take the necessary actions to bill and collect for these services; explore alternative sources for payment of health care setting services rendered; code, verify and modify demographic and insurance data obtained from source documents and enter such data into a computerized system; perform billings and collections functions in order to obtain maximization of health care setting's revenue; all Hospital Care Investigators perform related work.
Duties include but are not limited to:
- Perform in-depth interviews with self pay and/or insured patients, families, relatives and friends in an office setting or the hospital wards, during field investigations, and/or by telephone, email and mail to determine patients' and/or legally responsible relatives' ability to pay for service rendered.
- Responsible for screening uninsured or underinsured patients to identify insurance coverage or enrollment eligibility from WQ 9195, 9284.
- When necessary, obtain signatures for Medicaid application.
- Collect vital documents to complete and submit Medicaid application.
- Review and abstract Medical charts and Epic Media Manager program to obtain pertinent information for insurance purposes.
- Review patient account records to ensure patients are billed, verify and correct patient demographics.
- Utilize insurance websites/portals to verify insurance coverage information and/or other pertinent information that would aide in verification of coverage.
- Complete and submit Medicaid applications, charity care programs for eligible patients.
- Assist patients that do not qualify for Medicaid enrollment with charity care programs.
- Ensure all documentation is complete and submitted for program applications.
- Complete thorough HAR notes.
- Update and enter notes on all appropriate trackers.
- Perform routine follow-up on outstanding self-pay balances in WQ 9197, 9294.
- Acts as liaison with social services and client.
- Consult senior or supervisor in a timely manner.
- Compliance with all departmental, corporate, hospital regulations, policies and procedures and conformity to established time and leave requirements.
- Understand Time and Leave policy
- Adhere to Dress code
- Wear ID badge
- Appropriate professional conduct at all times towards patients, families, visitors, and co-workers.
- Attend all necessary training sessions to effectively perform the day-to-day functions of position.
Education Requirement:
- Baccalaureate Degree from an accredited college or university OR High School Diploma/educational equivalency approved by the State Department of Education or a recognized accrediting organization.
- College education may be substituted for experience on the basis that thirty (30) semester credits are equivalent to one (1) year of experience.
Qualifications/Requirements:
- Four (4) years of full-time experience in interviewing, investigation or related field such as credit and collection follow-up or bookkeeping
- NYSOH CAC, Bluemark & Revenue Cycle training experience is also required.
Knowledge, Skills, Abilities:
- Complete both paper and electronic claims in a timely manner.
- Effectively use computer systems to document patient information clearly and completely in the system.
- 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 the 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.
Benefits offered to our workers include the following:
- Medical Insurance
- Vision & Dental insurance
- Life Insurance
- 401K
- Commuter Benefits
- Employee Discounts & Rewards
- Payroll Payment Options
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