Hospital Care Investigator

Marketing Statement NYC Health + Hospitals/Carter is a state-of-the-art facility with a 4-Star CMS Quality Rating, equipped with 164-bed Skilled Nursing Facility and 201-bed Long-Term Acute Care Hospital (LTACH) based in Harlem. Carter excels at providing quality medical, sub-acute, rehabilitative, and long-term specialty services for individuals in need of medically-complex care like ventilator weaning and onsite-dialysis. Every employee takes a person-centered approach that exemplifies our ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnership. From more than 600 Nursing Homes in New York, Carter ranks #4 in Newsweek’s Best Nursing Homes in New York2026; and also received a high-performance rating for Long-Term Care and Short-term Rehabilitation from U.S. News & World Report’s Best Nursing Homes in America 2026. In 2025, Carter was awarded the American Nurses Credentialing Center’s Pathway to Excellence with Distinction Award, the nation’s first long-term facility to receive it. 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. Duties & Responsibilities Position Overview: Directly responsible for conducting financial investigations and related activities in health care facility to determine patients/client’s ability to pay for medical services or to determine alternative sources of payment, including eligibility for 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. Responsibilities Review all new and re-admit admission record received from centralized admission and screen for Long term, short term cases in addition to verification and confirmation of insurance coverage and send out email blast to all appropriate parties on updates needed.Responsible for screening uninsured or underinsured inpatient to identify insurance coverage or enrollment eligibility. Screening most often occur on the inpatient floors. Assist inpatient that do not qualify for enrollment with NYC Care or H+H options.Telephoning resident/families/responsible parties within 48 hours for initial interview, quoting facility daily rate, confirming demographic, verifying insurance coverage and request for financial documentation for Nursing Home Medicaid determination to be send via secure email. Scan patient ID, insurance card(s), and consent forms obtain from the patient into shared drive.Verify insurance coverage coded in Point Click Care (PCC) for discrepancies also verifies insurance coverage from various insurance portalsSending email to financial clearance team to verify secondary and commercial insurance found that is not coded in PCCDocument all transactions in PCC notes Act as liaison with social worker to assist in obtaining signature on significant documents from the attending physicians, and family membersFollow up on cases to ensure Medicaid submission are within 45 days and complete submission to HRA or follow up on documentation needed for submission and follow up on status of applications until a coverage determination is made. Certified Assistor Counselor (CAC) credentials enrolling consumer in health coverage through Affordable Care Act’s Health Insurance Marketplace.Maintains competency of MAPS (Electronic Portal for Medicaid application submission) on all Post-Acute Care outstanding cases needing to submit to HRA for determination of eligibility insurance Review transmission report in MAPS on approved, denied, deferred cases in MAPS for and update; maintains statistical records and prepares status reports.Refer accounts requiring escalation to Supervisor in a timely manner.Import/scan budget letter approvals into the computerized system (Point Click Care).Notify resident or responsible party of approved Medicaid with their monthly NAMI (Net Available Monthly Income) responsibility and encourage to sign up for RFMS electronic NAMI withdrawal and pension re-routing.Assist resident with annual Medicaid recertification for continuing eligibility insurance coverageUpdate UR tracker and attending weekly UR meeting to discuss residents needing Medicaid insurance coverage Courteously and properly handle or refer all calls received Serves as liaison between department administrative, technical and professional divisions and work harmoniously with a culturally diversified staff.Perform other duties as assigned by Manager relating to Eligibility field Minimum Qualifications A baccalaureate degree from an accredited college or university; orAn Associate’s degree from an accredited college or university; and completion of an accredited certificate program in medical billing; orA 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; orA 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; orEducation 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 Certified Assistor Counselor (CAC) credentials enrolling consumer in health coverage through Affordable Care Act’s Health Insurance Marketplace. 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 and Word. How To Apply If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.