Hospital Care Investigator -Provisional Appointment

Duties & Responsibilities

• 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.
• Facilitates 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
• Graduation from a Senior High School or a High School Equivalency Diploma;
• and Four (4) years of experience in interviewing, casework or a related field preferably in a hospital or health care facility setting;
• or A satisfactory equivalent combination of education, training and experience.