Investigator

Client Summary :

The nation's largest municipal health care delivery system in the United States dedicated to providing the highest quality health care services to all New Yorkers with compassion, dignity and respect, and regardless of immigration status or ability to pay.

Summary of Need :

• Perform in-depth interviews with self pay and / or insured patients, families, relatives and friends in an office setting or the hospital wards, during field investigations, and / or by telephone, email and mail to determine patients' and / or legally responsible relatives' ability to pay for services rendered.
• Responsible for screening uninsured or underinsured patients to identify insurance coverage or enrollment eligibility from WQ 9195, 9284
• When necessary, obtain signatures for Medicaid application.
• Collect vital documents to complete and submit Medicaid application.
• Review and abstract Medical charts and Epic Media Manager program to obtain pertinent information for Insurances purposes.
• Review patient account records to ensure patients are billed, verify and correct patient demographics.
• Utilize insurance websites / portals to verify insurance coverage information and / or other pertinent information that would aide in verification of coverage.
• Complete and submit Medicaid Applications, Charity Care programs for eligible patients.
• Assists patients that do not qualify for Medicaid enrollment with charity care programs.
• Ensure all documentation is complete and submitted for program applications.
• Complete thorough HAR notes.
• Update and enter notes on all appropriate trackers.
• Perform routine follow-up on outstanding self-pay balances in WQ 9197, 9294
• Acts as liaison with social services and Client
• Consult senior or supervisor with any questions, refer accounts requiring escalation to supervisor in a timely manner.
• Compliance with all departmental, corporate, hospital regulations, policies and procedures and conformity to established time and leave requirements.
• Time and Leave policy
• Dress code
• Wear ID badge
• Appropriate professional conduct at all times towards patients, families, visitors, and co-workers.
• Attend all necessary training sessions to effectively perform the day-to-day functions of position.

Qualifications / Requirements :

Baccalaureate Degree from an accredited college or university; or, High School diploma or its educational equivalent approved by the State Department of Education or a recognized accrediting organization, and four (4) years of full-time experience in interviewing, investigation, or a related field, such as credit and collection follow-up or bookkeeping;

or, Education and / or experience which is equivalent to "1" or "2" 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 High School diploma or its educational equivalent approved by the State Department of Education or a recognized accrediting organization.

Knowledge, Skills, Abilities :

• 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 in a timely manner.
• Process pre authorizations, documenting responses in the system and following up as needed
• Audit patient accounts for accuracy..
• Apply adjustments as needed.
• Provide billing costumer 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.
• Arrange payment schedules with patients. Refer accounts requiring escalation to Supervisor in a timely manner.
• Attend all necessary training sessions to effectively perform the day-to-day functions of the position Perform all other duties, as assigned by the Manager or Supervisor.

Shift / Schedule :

Monday through Friday

Contract Length : 8 weeks

Equiliem specializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum.

Our projects range from short to long term local and travel assignments. Equiliem has been recognized as a certified small business enterprise.

In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 5 years running by our employees and client partners.

Benefits offered to our workers include the following :

• Medical Insurance
• Vision & Dental insurance
• Life Insurance
• 401K
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

Equiliem ( www.equiliem.com ) believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.

Across the U.S., leading companies in healthcare, government, light industrial manufacturing, professional services, and energy rely on us for their workforce solutions.

Our recruiting and HR services include contract and direct hire staffing, Payrolling / EOR, and Independent Contractor Compliance.

For over 50 years, we've helped shape our industry. Today, we continue to research, ask questions, and constantly enhance the candidate journey and client experience

Last updated : 2024-05-08