Hosp Care Investigator

3 weeks ago

New York, United States NYC Health Hospitals Full time

NYC Health + Hospitals/Coler is an 815-bed nursing facility with a 5-Star CMS Quality Rating located on Roosevelt Island, nestled between Manhattan and Queens. Coler offers long term and subacute care, rehabilitation, and a dedicated memory care unit, comprised of 150 beds featuring an acclaimed music and memory program. The facility features a robust rehabilitation therapy program with expansive gym space for residents. Coler also offers full time physician staff, psychiatry, dental services, an onsite 8-chair dialysis den for hemodialysis, and on-site medical clinics to meet the clinical needs of its residents.

From more than 600 Nursing Homes, Coler ranks #5 in Newsweek's Best Nursing Homes in New York 2024; and also received a 2024 Silver Beacon Award for Memory Care.

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:

Under direct supervision responsible for conducting financial investigations and related activities in health care facility to determine patients/client's ability to pay for medical services; explore alternative sources for payment for medical services rendered; or to determine alternative sources of payment, including medical insurance coverage, reviewing case records, provide guidance and or direct investigations for complex cases to reach a resolution and facilitate payment; and perform related work assigned by manager.

ESSENTIAL FUNCTIONS:
• Review all new admission record received from centralized admission and screen for Long term, short term cases in addition to verification and confirmation of Managed Care coverage and obtain authorization.
• Coordinates and verify Secondary and Supplemental insurances and all demographic patient information via PCC, EPIC, Omnipro, EPACES, insurance portals, telephone or fax and reach out to various disciplines for additional documentation.
• Contact various insurances to obtain authorization, single case agreement for out of network plans and send out email blast to all appropriate parties with requisitions of clinical, information needed from the Case management team as requested by the insurance plan.
• Act as liaison with social worker to assist in obtaining letter and signature from the attending physicians, and family members to verify Permanent placement and obtain custodial and short term (ALOC) authorization for skilled nursing facility and participates in multidisciplinary meetings.
• Collect and analyzes related data needed to complete MAP-2159I for Long Term Placement for the Managed Care providers to sign off and subsequently distribute to appropriated eligibility staff for submission to HRA.
• Input all Managed Care cases into excel format and submit weekly list of all verified Managed Care Authorization to all Accounts Receivable managers and Management staff and save in the Patient Accounts Shared drive
• Import/scan authorization and Single Case agreements into the computerized system
• Maintain effective communication with Medical director to initiate the appeal process for continue care and coverage from Managed Care companies.
• Maintain all related records and documentations in Point Click Care (PCC) and Epic system.
• Responds to complex inquiries from Hospital Care Investigators and other duties as required in a professional and efficient manner.
• Communicates work related issues/problems to Direct Supervisor for appropriate follow up
• Courteously and properly handle or refer all calls received in a timely manner

Perform other duties as assigned and assist in coverage in the areas related to obtaining authorizations.

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 an accredited certificate program in medical billing; or
3.A four-year high school diploma or its educational equivalent; and completion of an accredited 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, at least two years of which must have been in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping; 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 and candidates must have completed an accredited certificate program in medical billing or have at least two years of full-time experience in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping. In addition, all candidates must have at least a four-year high school diploma or its educational equivalent.

Department Preferences

Ability to analyze a problem or situation and make appropriate judgments, such a logical conclusion, feasible solution or most appropriate action. Be cognizant of all HIPPA privacy rules to PHI. Proficiency in Microsoft Excel Word, and PowerPoint.

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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