Research Patient accounts related with audits and activity from Third Party Payers and internal audits in accordance with therequired timeframe. Identify and report root cause for all audit recoveries by Third Party Payers and recommends and participate in corrective action plan for Bronxcare Health System/MLK.
Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service Identifies and reports root causes for Audit recoveries by Third Party Payers and recommend /participate in corrective action for BCHS and MLK. Communicate with all Third Party Payers and internal parties to obtain required information to finish the assignment satisfactorily and within the required time frame.Responsible to ensure compliance regarding billing and timeliness on followup for all assigned accounts received. Utilizes all information systems toretrieve, verify and or appeal denied cases in payer web portal as appropriate Responsible for obtaining medical records for claims that are denied by the payer requesting clinical information. Obtains and submits medical records to the payer, as required. Reviews and obtains UM status and or action recorded
Three (3) to Five (5) years’ experience of collection in finance knowledge of Medicare and Medicaid reimbursement processing preferred Experience with the maintenance of the patient file information Experience in billing information systems Experience in a Health Care environment preferred Strong communication skills both verbal and writtenGood analytics skills Ability to multi-task and willingness to learn new skills Ability to deal effectively with multiple information sources
BronxCare is the largest voluntary, not-for-profit health and teaching hospital system serving the South and Central Bronx, with 859 beds and more than 4,500 employees. Its two main hospital divisions, comprehensive psychiatric and chemical dependency programs, long-term care facility, and extensive outpatient network of 39 practices are providing the wide range of services needed by the community. BronxCare is now among the largest providers of outpatient services in New York City, with close to 750,000 visits annually. Its ER is among the largest in the nation with 127,000 visits annually.
In 2023, BronxCare received full accreditation from the Joint Commission, the leading accrediting authority for hospitals in the nation. Its medical school affiliation with the Icahn School of Medicine at Mount Sinai and clinical collaboration with the Mount Sinai Health System, as well as 16 accredited residency and fellowship programs, are strong indicators of excellence. BronxCare’s outpatient practices are also certified as a Level Three Patient-Centered Medical Home (the highest designation) by the National Committee for Quality Assurance (NCQA).
As an engine for positive change, BronxCare has infused more than $400 million into the Bronx economy, including a new Pediatric Specialty Center and Ophthalmology Practice, among numerous other capital projects. A new 33-bed Medical-Surgical Unit at the Concourse Hospital Division and 20-bed Adult Psychiatric Unit at the Fulton Hospital Division will increase inpatient capacity to 912 beds, further reinforcing BronxCare’s ability to address the significant needs of the Bronx community.
BronxCare is also modernizing its Inpatient Maternity and Labor and Delivery Units, as well as its Women’s Health Center and Neurology Suite, to improve the patient experience. Additionally, BronxCare’s Dr. Martin Luther King, Jr. Health Center Practice at 174th Street will be opening.
