NYC Health + Hospitals/Coler is an 815-bed nursing facility with a 5-Star CMS Quality Rating located on Roosevelt Island, nestled between Manhattan and Queens. Coler offers long term and subacute care, rehabilitation, and a dedicated memory care unit, comprised of 150 beds featuring an acclaimed music and memory program. The facility features a robust rehabilitation therapy program with expansive gym space for residents. Coler also offers full time physician staff, psychiatry, dental services, an onsite 8-chair dialysis den for hemodialysis, and on-site medical clinics to meet the clinical needs of its residents. From more than 600 Nursing Homes, Coler ranks #5 in Newsweek's Best Nursing Homes in New York 2024; and also received a 2024 Silver Beacon Award for Memory Care.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.
Job DescriptionPOSITION OVERVIEW: Under general supervision of the Eligibility 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 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. Serves as principal assistant to Director of Patients Accounts Eligibility division and assumes full responsibility and authority in his/her absence. Ability to travel within the five Post-Acute Care Facilities.
SPAN OF CONTROL:Directly Supervises 13 Eligibility staff within the Post-Acute care Facility
ESSENTIAL FUNCTIONS: Managed and supervised of five Nursing Homes (Post-Acute Care Facilities) and Long-Term Acute Care Specialty Hospital, bed capacity of approximate 2,035 beds. Supervised thirteen staff ensuring the implementation of policies and procedures of the Corporation, NYSDOH and Patient Account Department of eligibility standards as they relate to the City, State and federal Programs for Medicare and Medicaid. Write, customized and implemented Standard Work for Post-Acute Facilities Collaborated with BlueMark (Electronic Portal for Medicaid application submission) and HRA in trouble shooting problems cases for the Post-Acute Facilities. Review Bluemark Medicaid software system on pending, approved or denied Medicaid cases and send out findings weekly email to Accounts Receivable (billing team) and Pharmscript via Secure email. Manages census and payer tree management in Point Click Care and EPIC system and validate for accuracy and conduct meetings with employees, managers, social workers, and Accounts receivable (billing) team. Reviewing various PCC and EPIC reports applicable to eligibility and reporting any changes to the billing staff 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. 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 Educated staff and Post-Acute Care population on the Medicaid and Managed Care process according to DOH and HRA guidelines in order that the Post-Acute Care Facilities remain in compliance. Request self-pay bill for residents who are ineligible for Nursing Home Medicaid due to excess resources and request comprehensive bills to be sent to the Public Administration on decease residents Communicate expectation with HCI staff, address deficiencies and assist in maintaining and increasing Medicaid eligibility by timely casework submission Training new staff member on eligibility functions, describe productivity to insure goals, complete Human Resources annual evaluations for Eligibility staff, and sign off on staff weekly timesheet 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 officePerform other duties as assigned by Eligibility Director
Minimum Qualifications1. A Master's degree from an accredited college or university in Public Health, Public Administration, Business Administration, Social Work, Psychology or Rehabilitation Counseling; and2. Two (2) years of full-time experience in medically-oriented health care and medical support systems environment, one (1) year of which included experience in an administrative or supervisory capacity in such occupations as physical, occupational, inhalation, speech and audiology therapy or as Medical/Laboratory Technologist, Microbiologist (various specialties), Chemist (biochemist), Radiation and X-Ray Technician; or two (2) years of responsible level experience in business management systems or general administration including one (1) year in a supervisory or administrative capacity; or3. A Baccalaureate degree from an accredited college or university in disciplines listed in 1 above; and4. Three (3) years of full-time experience, as described in 2 above, including two (2) years of experience in an administrative or supervisory capacity in occupations, as listed in 2 above; or5. A satisfactory equivalent combination of education, training and/or experience.Note: Certification or licensure may be required.
Department PreferencesGeneral 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. Ability to analyze a problem or situation and make appropriate judgments, such a logical conclusion, feasible solution or most appropriate action. Be cognizant of all HIPPA privacy rules to PHI. Proficiency in Microsoft Excel and Word and maintains statistical records and prepares status reportsIf you wish to apply for this position, please apply online by clicking the Apply Now 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