Hospital Care Investigator

Duties & Responsibilities Purpose of Position 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. Examples Of Typical Tasks 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. Contacts outside agencies, organizations, insurance carriers and employers to obtain necessary information about potential sources of revenue. Acts as a liaison with social services and home care agencies. 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. Facilities processing of patients’ applications for third-party benefits, including but not limited to Medicaid and Medicare. 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. Reviews patient account records to ensure patients are properly billed; verifies and corrects patient bills and codes information for computerized system. Verifies accuracy of patient information stored in computer and codes changes and modifications, as necessary. Responds to complex inquiries from patients and third-party payers and resolves disputes concerning bills submitted for payment. Follows up on collections to ensure maximization of revenue. Minimum Qualifications A baccalaureate degree from an accredited college or university; or An Associate’s degree from an accredited college or university; and completion of an accredited certificate program in medical billing; or 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 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 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. #J-18808-Ljbffr NYC Health + Hospitals