Hospital Care Investigator

About NYC Health + Hospitals

Lincoln Medical and Mental Health Center is one of New York Citys premier acute care hospitals. Located in Downtown Bronx, Lincoln is a teaching hospital renowned for its Centers of Excellence, and a recognized industry leader in the implementation of state-of-the-art medical technology and best practices. Our team of highly trained and caring medical professionals is dedicated to providing the highest quality health care that is safe, compassionate, culturally competent, and patient-centered. Comprehensive services are offered in three major primary care areas: Medicine, Pediatrics, and Womens Health in addition to more than eighty (80) specialty services. At Lincoln, the safety and comfort of our patients is our number one priority.

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.

Visit us at www.nyc.gov/html/hhc/lincoln.

Job Description

Purpose of Position:

A member of the revenue cycle process, Billers are responsible for reviewing accounts, correcting claim edits, preparing and completing claims for submission to payers, and updating patient accounting systems. The Billers also perform related functions in support of the Patient Financial Services operations and other duties, as assigned.

Specific Duties and Responsibilities

The Hospital Care Investigator is charged with and responsible for:

The identification of essential functions below is not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to the position within the revenue cycle process.

• Complete both paper and electronic claims, in a timely manner
• Effectively use computer systems
• Document patient information clearly and completely in systems
• Interact with other departments to complete billing on accounts
• Process rejections, denials, and other correspondence timely
• Process preauthorization, documenting responses in the system, and following up as needed
• Audit patient accounts for accuracy
• Apply and process refunds, adjustments, and credits as needed
• Provide billing customer service and ensure that conversations are documented accurately
• Processing statements and entering information into database, and reviewing past due bills and following up on past due accounts
• Generate Patient Balance Aging report and Insurance Aging report and following with patients and insurances accordingly.
• Posting payments received by patients, lockbox, or insurance timely
• Refer accounts requiring escalation to supervisor timely
• Attend all necessary meetings and training sessions to effectively perform the day-to-day functions of the position
• Perform all other duties, as assigned by the Manager or Supervisor
• Perform all duties in alignment with the mission, vision, values, and behavioral expectations of NYC Health + Hospitals

Minimum Qualifications

1. A Baccalaureate Degree from an accredited college or university; or

2. An Associates 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 customers 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

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. However, 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 discount programs

Public Service Loan Forgiveness Program (PSLF): The federal government provides student loan forgiveness through its Public Service Loan Forgiveness Program (PSLF) to all qualifying public service employees. Please visit the PSLF website for eligibility information: