The Hospital Care Investigator plays a vital role in the revenue cycle by managing billing, follow-ups, insurance claims, and patient financial services. The role includes reviewing accounts, resolving edits, preparing claims, processing payments, and supporting the broader financial operations of the hospital.
Responsibilities:Prepare and submit complete and accurate paper and electronic claims
Use computer systems efficiently to document and process patient information
Follow up with insurance companies for authorization and claim resolution
Process denials, rejections, and correspondence in a timely manner
Audit accounts for accuracy and apply necessary adjustments
Provide patient billing support and document communications accurately
Generate and follow up on patient and insurance aging reports
Assist with payment arrangements and escalate issues to supervisors when needed
Participate in required training and carry out additional tasks as assigned
Proficiency in medical billing systems and insurance claim processing
Strong documentation and communication skills
Ability to work with cross-functional departments
Knowledge of patient account auditing and adjustments
Customer service and problem-solving abilities
Ability to manage and follow up on outstanding balances
One of the following must be met:
Bachelor’s Degree from an accredited institution
OR
High School Diploma or equivalent plus four (4) years of relevant full-time experience in interviewing, investigations, credit, collections, or bookkeeping
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