Senior HCPPA- L B

Woodhull Medical and Mental Health Center is attuned to the healthcare issues that matter to the people of North Brooklyn. Woodhull focuses on preventing disease and promoting healthy lifestyles by reaching out to the community at various convenient locations.

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.

Work Shifts

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

Job Description

SUMMARY OF DUTIES AND RESPONSIBILITIES

• Establish workflows for Care Management support staff.
• Support the Adverse Appeal Process.
• Collaborate with senior staff to establish and refine workflows for Accountable Care Managers.
• Careport administrator for the hospital.
• Monitor, review, maintain and advise senior staff of the status and/or possible interventions needed to address In the Care Management Workqueues to assist in revenue recoupment.
• Denials Not Started
• Denials in Progress
• Denials Pending Insurance Response
• Escalate issues to appropriate departments to maximize revenue recoupment.
• Generate and distribute daily reports to Care Management Departments.
• Implement and revise existing Care Management processes to ensure timely reimbursement.
• Assist in tracking compliance with training and registration for courses within department.
• Communicate with other departments to resolve denials and clear accounts in a timely manner, preventing delayed throughput.
• Assist in Length of Stay management by categorizing patterns and trends to identify opportunities for improvement.
• Timely submission and follow-up for denials and appeals with the managed care insurance companies.
• Work closely with Patient Access and Accounting Department for all denials received.
• Maintain a list of outstanding initial and final adverse determinations to follow up with Managed Care Companies.
• Consults with management about issues that impact the maximization of revenue.
• Responsible for training staff with the use computer systems such as Epic, various insurance websites and PC skills i.e. Microsoft Work or Excel.
• Review and obtain slicer dicer and crystal reports used by the department in Epic.
• Escalate issues to Management that affect the HB AR (hospital billing accounts receivable). Overview dashboard with encounters that are in the Case Management Bucket in regards to the Low Hanging Fruit Report.
• Responsible for employee supervision, performance and employee development of assigned personnel in areas of responsibility and accountability.
• Assists in maintaining various work queues: ALOC, Communication and Denials.
• Scan correspondence into On Base.
• Document denial/appeal progression.
• Assist with special projects as necessary.

Complete task assigned by the Director of the department.

Minimum Qualifications
1. A Baccalaureate Degree from an accredited college or university in Business Administration, Engineering or Social Sciences, Health Care Specialization, Physical Sciences or related programs; and
A minimum of four years of progressive, responsible experience related to Health Care Program Planning, Research, Design, Operation, Evaluation and Analysis; or
2. A Masters Degree from an accredited college or university in Public Health, Public or Hospital Administration, Health Care Specialization, Business Administration or related disciplines; and
A minimum of three years progressive, responsible experience directly related to health care program planning, research, design, operation, evaluation and analysis; or
3. A satisfactory equivalent combination of training, education and experience; and,
4. Demonstrated skills in written and oral communication.

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

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