Job Details
Carter is a leading, comprehensive specialty care hospital and nursing facility dedicated to providing quality medical, sub-acute, rehabilitative and long-term specialty services. We are committed to serving the New York City and surrounding communities while setting the example as a national leader in long-term and subacute care with centers of excellence in areas such as: geriatrics, rehabilitation and ventilator dependence.
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.
Job Description
Position Overview: Under direct supervision, conducts investigations to determine the ability of patients and their legally responsible relatives to pay medical charges; explores alternative sources for payment for medical services rendered; verification of authorization and requests initial authorization for custodial care services; communicates regularly and working collaboratively with Central Admission team for the six (6) Post-Acute care facilities in pre-screening of all admission referrals to receive a consent/approval acknowledgment before client admission to Post-Acute Care facilities to obtain maximization of hospital's revenue; adheres to financial clearance standard work; perform other related work.
Responsibilities:
Review the six (6) Post-Acute care facility ACB census received via email from Central Admission for verification of payer source; communicate with potential residents/patients/designated representative or social worker from referring facility as it relates to the insurance plan coverage with the understanding of involved deductibles, co-pays and co-insurance amount which resident/patient or their designated representative must pay the incurred bill from Primary insurance exhausted/non-covered date through discharge; if there is no secondary insurance involved to cover such expenses then quote facility daily rate and refer the client to speak with a financial counselor or billing manager on a financial agreement for private payment.
Conduct verbal communication with HARP insured before being admitted to PAC facility to educate them of their insurance policy not covering custodial long-term placement and encouraging the process to request disenrollment/transition to Mainstream Medicaid Managed Care plan to cover for Long long-term care Placement in Post-Acute Care Facility
Communicate with potential residents/patients/designated representative on Medicaid guidelines as it relates to Medicaid eligibility with monthly NAMI responsibility, Medicaid transfer rules with penalty period, Medicaid recertification, Medicaid excess resources with financial agreement, Medicaid recertification and compliance with supplying updated financial documentation every year to recertify of continue Medicaid eligibility
Explain monthly NAMI responsibility based on monthly income and request immediate re-routing of monthly income (Social Security, annuity payments, etc.)
Explaining the Long-Term Placement process (MAP-2159I) for our Medicaid Managed Care insured and initiating a request for custodial authorization
PAC admission agreement will be explained to potential new residents/patients and encouraged to sign upon agreement of transfer to a Post-Acute Care Facility
Explain if the resident/patient qualifies for Medicaid, the application will be submitted by the facility financial representative, and is requesting to furnish the full and completed documentation as required by the Medicaid office within a timely manner
Encourage signing of RFMS form before Post-Acute Care admission
Answer questions/concerns courteously, offer guidance and escalate issues as needed to the Patient Account manager and Director
Provides training and in-service for existing employees and new hires, provides support to staff development and process improvement to enhance quality of work activity, and communicates strategic departmental goals
Participates in revenue cycle service monthly meetings and ensures adequate records of activities and problems are maintained as appropriate
Complete special projects as assigned by the Patient Accounts Manager and Director
Perform other duties as assigned and assist in coverage in the areas related to obtaining authorizations.
Minimum Qualifications
1. A Baccalaureate Degree in a relevant field from an accredited college or university; and,
2. One year of experience in business, government, hospital, educational institute or non-profit organization in analysis, development and implementation of systems, methods and procedures, management information development and data coordination.Familiarity with EDP applications and data processing programs; or,
3. A Masters Degree in Management, Business Administration, Hospital Administration Management, Public Administration, Accounting or relevant field from an accredited college or university; or,
4. A satisfactory combination of education, training and experience.
If you wish to apply for this position, please apply online by clicking the "Apply Now" button or go to employment.nychhc.org
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
- Loan Forgiveness Programs for eligible employees
- Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
- College tuition discounts and professional development opportunities
- Multiple employee discounts programs