Hospital Care Investigator (000494)

A member of the revenue cycle process, responsible for reviewing accounts, correcting claim edits, preparing and completing claims for submission to payers, posting all types of payments, and updating patient accounting systems. Perform related functions in support of the Patient Financial Services operations and other duties, as assigned. 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.

• 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 the 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.

• 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 and apply adjustments as needed.
• Provide billing customer service and ensure that conversations are documented accurately.
• Process statements and enter information into the database; review past due bills and follow up on past due accounts.
• Generate Patient Balance Aging report and Insurance Aging report and follow up 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.