Work Shifts

9:00 A.M - 5:00 P.M

Duties & Responsibilities

Position Overview:

Under general supervision of the Assistant Director, assists in planning, organizing and supervising the functions and day-to-day activities of Financial Eligibility determination as relating to financial investigation and/or billing and collection sections. Participates in implementation of policies, systems and procedures relating to staffing, supervision of personnel, coordination, control, audit and review of required activities to maximize collection of in-patient and outpatient billings, in accordance with policies and procedures established by the Corporation including preparation for billing, follow-up of collection cycle procedures, and maintenance of documentation flow for reimbursement. Streamlining processes for submission of new and conversion applications utilizing software for electronic transmission while ensuring their effectiveness, proficiency and productivity. Serves as principal assistant to Director of Patients Accounts Eligibility division and assumes full responsibility and authority in his/her absence.

Responsibilities:

• Managed and supervise of five Nursing Homes (Post-Acute Care Facilities) and Long-Term Acute Care Specialty Hospital, and newly opened Outpatient Clinic with totaled inpatient bed capacity of approximate 2,035 beds.
• Supervise eighteen staff ensuring the implementation of policies and procedures of the Corporation, NYSDOH and Patient Account Department
• Write, customized and implemented Standard Work for Post-Acute Facilities with the eligibility department
• Review all new and re-admit admission record received from centralized admission and screen for Long term, short term cases in addition to verification, confirmation of insurance and authorization coverage and send out email blast to all appropriate parties on updates needed with attending weekly UR meeting to discuss residents in need of Medicaid insurance coverage.
• Manages census and payer tree management in Point Click Care (PCC) and EPIC system and validate for accuracy of eligibility insurance coverage with verifying of eligibility HCI completion of Medicare Secondary Payer Questionnaire (MSPQ) assessment
• Reviewing various PCC and EPIC reports applicable to eligibility, authorization and reporting any changes to the billing staff
• Communicate expectation with HCI eligibility and authorization staff, address deficiencies and assist in maintaining and increasing Medicaid eligibility.
• Educated staff and Post-Acute Care population on the Medicaid and Managed Care process according to NYSOH, DOH and HRA guidelines in order that the Post-Acute Care Facilities to remain in compliance.
• Training new staff member on eligibility and authorization functions, sign off on timesheets and monthly time and grant reports with annual completion of employee job performance evaluations.
• Facilitate weekly eligibility meetings with financial counseling staff to ensure fully documented Medicaid applications are submitted to HRA (local Medicaid office) within 45 days of admission; with follow up on status of applications until a coverage determination is made.
• Follow up on cases to ensure Medicaid submission are within 60 days of admission and send email to HCI for submission or follow up on documentation needed.
• Assist uninsured resident that do not qualify for Medicaid insurance and assist with enrollment of NYC Care or H+H options
• Request self-pay bill for residents who are ineligible for Nursing Home Medicaid due to excess resources with endorsement to eligibility staff for hand delivery to secure payer source for services rendered; and request comprehensive bills to be sent to the Public Administration on decease residents.
• Ensure that HRA provides copy of budget letter on all approved Medicaid application and eligibility financial counseling staff uploads budget letters in respective billing system (PCC or EPIC)
• 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
• Social Security and Private Pension reroute request for Long Term Placed residents with calculated monthly Medicaid responsibility not being covered (NAMI/excess income).
• Outreach to resident and their responsible party on outstanding NAMI and Private pay collections cases.
• Maintains competency of MAPS (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 MAPS on approved, denied, deferred cases in MAPS for and update; maintains statistical records and prepares status reports
• Assess, collect paperwork, prepare Guardianship Referral for submission to Corporation Counsel, sign Guardianship Petition, and attend guardianship court hearing and monitor progress
• Assessment along with Social Work Department cases that lack citizenship documentation for NYLAG referral
• Transmit Nursing home roster received from DOH into Excel format, compare with prior month roster for any changes in insurance plan, and send findings to eligibility and billing staff and Managed Care coordinators to obtain custodial authorization.
• Collaborated with MAPSng (Electronic Portal for Medicaid application submission) and HRA in trouble shooting problems cases for the Post-Acute Facilities
• Monthly verification of all MLTC (Medicaid Managed Long Term Care Partial Capitation) insured residents to confirm timely submission of MAP-2159I (Permanent placement) for input of N1/N6 exception code as requested by the health plan insurance.
• Prepare quarterly report on all MLTC insured resident and submit to Department of Health of batch disenrollment into the fee-for-service Medicaid for ongoing coverage of their long-term nursing home care.
• Make referrals for Medicare enrollment on residents turning 65 years old and submission of disenrollment on Medicare advantage insurance plans.
• Review and sign off on monthly time and grant report and submit to respective team
• Coordinate and review work of subordinates relating to assigned tasks;
• Monitored the operations and efficiency of the office;

Minimum Qualifications
1. Bachelor's degree from an accredited college or university in Accounting, Finance, Business Administration, Hospitality Management or a related discipline; and 2.Three (3) years of experience in accounting, finance or business administration; one (1) year of which must have been in a responsible supervisory or managerial capacity managing accounts or credits.

Department Preferences

Certified Assistor Counselor (CAC) credentials enrolling consumer in health coverage through Affordable Care Act's Health Insurance Marketplace. General knowledge of policies and program utilized in the operation of health care facility ability to assimilate and analyze data, to recommend action based on analytical findings, and to assist in the solution of complex problems in health care administration and management. Be cognizant of all HIPPA privacy rules to PHI. Proficiency in Microsoft Excel and Word and maintains statistical records and prepares status reports.

Benefits

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.