Financial Investigator

BronxCare Health System•New York, NY

13d•$31 - $32

About The Position

The Financial Investigator secures pre-authorizations for medical and ancillary services and communicates daily with practice managers, clinicians, and staff to ensure visits are properly registered and meet insurance pre-authorization requirements. The role supports timely authorization processing, accurate submission and entry of authorization requests into the Allscripts Clinical Registration System, and reduced payment denials for unauthorized services. The position reviews patient utilization data, obtains clinical information needed for insurance carrier review, communicates authorization decisions, and follows up on outstanding cases. It also serves as a liaison among clinics, physicians, patients, staff, insurers, and ancillary departments. The Financial Investigator is expected to maintain professionalism and confidentiality and comply with applicable Federal and State regulations, including HIPAA and EMTALA.

Requirements

At least two years of hospital or healthcare experience in financial investigations, insurance verification, and/or insurance authorization.
Excellent customer service skills.
High school diploma or GED.
Basic computer knowledge.

Responsibilities

Establish and maintain positive, professional relationships with patients, visitors, and employees, supporting a positive public perception of BronxCare Health System.
Participate in departmental Performance/Quality Improvement activities, including data collection and analysis, risk management and claims activities, Continuous Quality Improvement teams, and compliance with applicable safety, security, incident reporting, infection control, and patient service policies.
Obtain and process authorization requests for medical and ancillary services promptly, submit requests accurately, and enter authorizations into the Allscripts Clinical Registration System.
Respond promptly to pre-authorization, authorization, and pre-certification requests from points of service within BronxCare Health System ambulatory practices.
Retrieve and review patient utilization data to secure authorization for scheduled services, and update practice administrative personnel and care providers about insurance carrier decisions.
Navigate Allscripts EMR (Acute Care) and communicate with practice administrative staff or care providers to obtain clinical utilization data needed for insurance carrier review and timely authorization approval.
Communicate daily with practice managers, clinicians, and PFS staff to ensure visits are appropriately registered and meet insurance pre-authorization requirements, helping reduce payment denials for unauthorized services.
Maintain accurate productivity and outstanding-item reports and follow up on outstanding cases as needed.
Act as a liaison with clinics, physicians, patients, staff, insurers, and ancillary departments while maintaining positive relationships.
Maintain professionalism and confidentiality and comply with Federal and State regulations, including HIPAA and EMTALA.