Hospital Care Investigator

3 weeks ago

New York, New York, United States NYC Health Hospitals Full time

NYC Health + Hospitals/Metropolitan is a community hospital of choice for residents of East Harlem, northern Manhattan, and neighboring communities. The hospital provides culturally-sensitive care in a welcoming and hospitable setting, emphasizing primary care medicine and utilizing the latest advances in medical science. Metropolitan delivers high quality health services with compassion, dignity, and respect to all, without exception. Since its founding in 1875, the hospital has been affiliated with New York Medical College, representing the oldest partnership between a hospital and a private medical school in the United States. Metropolitan is a part of the NYC Health + Hospitals, the largest municipal hospital and health care system in the country.

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

Key Responsibilities:
1. Verify patient insurance eligibility and benefits for all patients requesting services at NYC H+H Metropolitan.
2. Conduct comprehensive System Checks for the uninsured population and/or when no insurance has been identified. This also includes telephone interviews with patients when all other tools and/or options have been exhausted.
3. Submit authorization requests and financially clear all procedures and/or clinic visits that populate on a Referral Workqueue for authorization.
4. Submit online authorization requests to Evicore insurance companies for patients scheduled for Imaging Services.
5. Communicate any issues that may arise after the request for authorization has been submitted with the Ordering Provider and Attending via email. This will include requests for additional notes, denials, and any other correspondence received from the initial request.
6. Facilitate Public Health Insurance screening and enrollment via the NY State of Health for the uninsured populations requesting Imaging Services.
7. Accurately update and revise Demographic, Biographic, and Insurance information in EPIC.
8. Inform patients or their representatives via mail and/or telephone of their scheduled appointment date, time, and location.
9. Perform customer service and/or billing inquiries for patients presenting with account issues, billing issues, etc.
10. Conduct patient interviews and/or pre-screening processes to obtain identifying/qualifying Demographic, Biographic, and Insurance information to assist with completing the New Patient Registration process.
11. Demonstrate the ability to be flexible, organized, and function efficiently in a fast-paced environment.
12. Follow and adhere to all steps in the Advanced Imaging workflow.
13. Other assignments and special projects as deemed necessary and/or appropriate by the Department.

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.

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
Vacancy Control Board Number

MET

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