Hosp Care Investigator

NYC Health + Hospitals/Coler is a certified 815-bed nursing facility with a 5-Star CMS Quality Rating located on Roosevelt Island, nestled between Manhattan and Queens. Coler offers long term and subacute care, rehabilitation, and a dedicated memory care unit, comprised of 150 beds featuring an acclaimed music and memory program. The facility features a robust rehabilitation therapy program with expansive gym space for residents. Coler also offers full time physician staff, psychiatry, dental services, an onsite 8-chair dialysis den for hemodialysis, and on-site medical clinics to meet the clinical needs of its residents.

From more than 600 Nursing Homes in New York, Coler ranks #10 in Newsweek’s Best Nursing Homes in New York 2026; earned 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; and received a 2024 Silver Beacon Award for Memory Care.

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.

9:00 A.M – 5:00 P.M

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.

ESSENTIAL FUNCTIONS:

• 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.

• 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.

• Verify insurance coverage coded in Point Click Care (PCC) for discrepancies also verifies insurance coverage from various insurance portals

• Sending email to financial clearance team to verify secondary and commercial insurance found that is not coded in PCC

• Document 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 members

• Follow up on cases to insure Medicaid submission are within 60 days and complete submission to HRA or follow up on documentation needed for submission

• Maintains competency of BlueMark (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 BlueMark on approved, denied, deferred cases in BlueMark and assigned to HCI for review and update; maintains statistical records and prepares status reports.

• Import/scan budget letter approvals into the computerized system

• 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

• Assist resident with annual Medicaid recertification for continuing eligibility insurance coverage

• Update 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

1.A baccalaureate degree from an accredited college or university; or
2.An Associate’s degree from an accredited college or university; and completion of an accredited certificate program in medical billing; or
3.A 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; or
4.A 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; or
5.Education 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.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• Loan Forgiveness Programs for eligible employees
• College tuition discounts and professional development opportunities
• College Savings Program
• Union Benefits for eligible titles
• Multiple employee discounts programs
• Commuter Benefits Programs

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.