Hospital Care Investigator
3 weeks ago
**About NYC Health + Hospitals**:
Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation Medicine, Renal and Mental Health Services.
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.
**Work Shifts**:
9:00 A.M - 5:00 P.M
Under direct supervision, conducts 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 takes the necessary actions to bill and collect for these services; explores alternative sources for payment for health care setting services rendered; codes, verifies and modifies demographic and insurance data obtained from source documents and enters such data into a computerized system; performs billings and collections functions in order to obtain maximization of health care setting’s revenue; all personnel perform related work.
**Duties & Responsibilities**:
1. Informs patient of health care setting rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the health care setting, during field investigations, and/or by telephone to determine patients’ and/or legally responsible relatives’ ability to pay for services rendered.
2. Contacts outside agencies, organizations, insurance carriers and employers to obtain necessary information about potential sources of revenue.
3. Acts as a liaison with social services and home care agencies.
4. Refers patients to various health care setting departments and outside agencies, such as Medicaid, New York State Unemployment Insurance, Social Security and Public Assistance for possible benefits.
6. 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.
7. Reviews patient account records to ensure patients are properly billed; verifies and corrects patient bills and codes information for computerized system.
8. Verifies accuracy of patient information stored in computer and codes changes and modifications, as necessary.
9. Responds to complex inquiries from patients and third-party payers and resolves disputes concerning bills submitted for payment.
10. Follows-up on collections to ensure 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
**How To Apply**:
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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