Hospital Care Investigator - (00044066) (PROVISIONAL)
Compensation: $65,090.00 - $95,690.00 /year *
Employment Type: Full-Time
Industry: Financial Services - Insurance
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Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation Medicine, Renal and Mental Health Services.Job Description
Purpose of Position:
Under direct supervision, conducts investigations to determine ability of patients and their
legally responsible relatives to pay hospital charges; explores alternative sources for
payments for hospital services rendered; codes, verifies and modifies demographic and
insurance data obtained from source documents onto coding forms for later entry into
computerized system; performs billings and collections functions in order to obtain
maximization of hospital s revenue; performs related work.
Examples of Typical Tasks:
1. Informs patient of hospital rates; performs in-depth interviews with patients, families,
relatives and friends in an office setting or the hospital, during field investigations,
and/or by telephone to determine patients and/or legally responsible relatives ability
to pay for services rendered.
2. Contacts outside agencies, organizations, insurance carriers and employers to obtain
necessary information about potential sources of revenue.
3. Acts as liaison with social services and home care agencies.
4. Refers patients to various hospital departments and outside agencies, such as
Medicaid, New York State Unemployment Insurance, Social Security and Public
Assistance for possible benefits.
5. Facilities processing of patients applications for third party benefits, including but
not limited to Medicaid and Medicare.
6. 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.
7. Reviews patient account records to insure patients are properly billed; verifies and
corrects patient bills and codes information for computerized system.
8. Verifies accuracy of patient information stored in computer and codes changes and
modifications, as necessary.
9. Responds to complex inquiries from patients and third party payers and resolves
disputes concerning bills submitted for payment.
10. Follows up on collections to insure maximization of revenue.Responsibilities
1. A Baccalaureate Degree from an accredited college or university; or
2. Graduation from a Senior High School or a High School Equivalency Diploma; and
3. Four (4) years of experience in interviewing, casework or a related field preferably in a hospital or health care facility setting; or
4. A satisfactory equivalent combination of education, training and experience.Vacancy Control Board Number
VCB #: ELM-06192###-####
Associated topics: adjuster, auto, casualty, claim adjuster, claim investigator, claimant, insurance, insurance adjuster, insurance investigator, liability
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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