Healthcare Investigator
2 days ago
NYC Health + Hospitals/Gouverneur is a 295-bed Skilled Nursing Facility (SNF) with a 5-Star CMS Quality Rating located in Manhattan's Lower East Side neighborhood. Our facility offers enhanced, cutting-edge healthcare services in a state-of-the-art space, providing 24-hour care for individuals in need of sub-acute care, long-term care, or hospice care.
Job SummaryUnder direct supervision, the Healthcare Investigator will conduct financial investigations and related activities to determine patients' ability to pay for medical services, explore alternative sources for payment, and facilitate payment. The ideal candidate will have a baccalaureate degree and four years of experience in interviewing, investigation, or a related field.
Key Responsibilities- Review new admission records, screen for long-term and short-term cases, and verify Managed Care coverage.
- Coordinate and verify Secondary and Supplemental insurances, demographic patient information, and obtain authorization.
- Act as liaison with social workers to assist in obtaining letters and signatures from attending physicians and family members.
- Collect and analyze data to complete MAP-2159I for Long Term Placement and submit to Managed Care providers.
- Input Managed Care cases into Excel format and submit weekly lists to Accounts Receivable managers.
- Maintain effective communication with Medical Directors to initiate appeal processes.
- Respond to complex inquiries and perform other duties as required.
- Baccalaureate degree from an accredited college or university.
- Four years of experience in interviewing, investigation, or a related field.
- Ability to analyze problems and make judgments.
- Proficiency in Microsoft Excel, Word, and PowerPoint.
- Comprehensive health benefits for employees hired to work 20+ hours 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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