Hospital Care Investigator Resume Samples

A Hospital Care Investigator plays a crucial role in improving the quality of patient care and safety within the hospital facility. The job description included on the Hospital Care Investigator Resume – conducting investigations into incidents, overseeing and rectifying medical errors, breaches, and allegations in patient safety protocols; gathering evidence, reviewing medical records, analyzing data to determine the root cause; assessing if the healthcare providers adhere to industry standards; conducting on-site inspections, reviewing policies; ensuring the patient safety protocols are followed; and creating a detailed report that summarizes the findings and recommendations.

The needed skills to excel in this role are – strong analytical skills to assess complex situations, effective communication skills; the ability to investigate the accuracy and reliability of the findings; a solid understanding of healthcare regulations, and patient safety protocols, and familiarity with laws and regulations governing the field. Most employers prefer a bachelor’s degree in healthcare administration or a related field. Work experience in healthcare administration of quality improvement is highly valued.

Hospital Care Investigator Resume example

Senior Hospital Care Investigator Resume

Summary : As a Senior Hospital Care Investigator, worked with patients and families in the inpatient setting to identify and obtain coverage for uninsured or underinsured patients, interviewed patients and families to determine coverage eligibility, submitted applications for insurance coverage, and followed up on applications through resolution.

Skills : Medical Knowledge, Analytical Skills.

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Description :

  1. Screened uninsured or underinsured inpatients to identify insurance coverage or enrollment eligibility.
  2. Screened most often occurs on the inpatient floors, assisted patients who do not qualify for enrollment with charity care programs.
  3. Ensured all documentation was complete and submitted for program applications.
  4. Scanned patient ID, insurance cards, referral forms (if applicable), and consent forms obtained from the patient into the document imaging system.
  5. Followed up on the status of applications until a coverage determination was made, coordinated with Case Management and/or Social Work to support patients and families through the application process.
  6. Documented patient information clearly and completely in the Health Information System (HIS).
  7. Promoted a positive and pleasant attitude conducive to the workplace which enhances and furthers the Mission, Vision, and Value Statements.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor's Degree in Healthcare Administration


Hospital Care Investigator Resume

Summary : As a Hospital Care Investigator, completed both paper and electronic claims, in a timely manner, for review and processing by the Supervisor, effectively used billed computer systems, Under direct supervision, conducted investigations to determine the ability of patients and their legally responsible relatives to pay hospital charges.

Skills : Attention to Detail, Investigative Skills.

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Description :

  1. Explored alternative sources for payments for hospital services rendered.
  2. Coded, verified, and modified demographic and insurance data obtained from source documents onto coding forms for later entry into a computerized system.
  3. Performed billings and collections functions in order to obtain maximization of the hospital's revenue; performed related work.
  4. Acted as liaison with social services and home care agencies.
  5. Refer patients to various hospital departments and outside agencies, such as Medicaid, New York State Unemployment Insurance, Social Security, and Public Assistance for possible benefits.
  6. Supervised a unit engaged in medical assistance, investigation activities, assigning and controlling the flow of work, training and advising subordinates in difficult matters, evaluating staff and recommending appropriate personnel action when indicated.
  7. Reviewed case records and/or recommendations for approval or denial and for appropriateness of category of assistance.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor's Degree in Nursing


Junior Hospital Care Investigator Resume

Objective : As a Junior Hospital Care Investigator, responsible for reviewing and abstracting Medical charts to obtain pertinent information for accurately coding and completing third-party billing forms, indicating treatment given, discharge diagnoses, and overall patient information for computerization purposes.

Skills : Data Analysis, Regulatory Knowledge.

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Description :

  1. Verified and corrected patient bills and code information for the computerized system.
  2. Verified the accuracy of patient information stored in the computer and coded changes and modifications, as necessary.
  3. Billed the payer and contacted insurance payers to review claims that have not been paid after a reasonable period of time and follow through to resolution
  4. Ensured compliance with payer rules and regulations, billing various payers including Medicare and Medicaid
  5. Performed routine follow-up on outstanding insurance balances, reviewed and worked appropriate accounts to maximize A/R reduction and minimize write-offs.
  6. Reviewed payer denials and underpayments and worked to resolution.
  7. Interpreted departmental, City, State, and Federal rules and regulations for the unit staff.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's Degree in Criminal Justice

Assistant Hospital Care Investigator Resume

Objective : As an Assistant Hospital Care Investigator, completed claims for review and processing by the Supervisor (Senior HCI), Interacted with other departments to resolve outstanding payer balances, and referred accounts requiring escalation to the Supervisor (Senior HCI) in a timely manner.

Skills : Communication, Computer Proficiency.

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Description :

  1. Attended all necessary training sessions to effectively perform the day-to-day functions of the position.
  2. Demonstrated an acceptable level of professional development through attendance at outside and Central Brooklyn Network Sessions.
  3. Took all necessary actions to ensure a safe environment, and secured patient records to ensure the confidentiality of information.
  4. Exhibited flexibility as it pertains to work assignment, workplace site designation, and tour of duty.
  5. Determined eligibility of applicants for medical assistance at public expense, or a unit reviewing applications or conducting investigations of non-hospitalized and noninstitutionalized applicants for medical assistance, or a unit of Hospital Care Investigators engaged in other related activity; performed related work.
  6. Supervised a unit engaged in medical assistance, investigation activities, assigning and controlling the flow of work, training and advising subordinates in difficult matters, evaluating staff, and recommending appropriate personnel action when indicated.
  7. Assisted uninsured patients and patients with inadequate insurance coverage- applying them for Medicaid, QHP, and HHC options.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelor's Degree in Healthcare Administration

Hospital Care Investigator Resume

Objective : As a Hospital Care Investigator, reviewed case records and/or recommendations for approval or denial and for appropriateness of category of assistance, authorized or denied medical assistance for inpatient care, and determined eligibility for other medical assistance.

Skills : Legal, Ethical Awareness.

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Description :

  1. Conducted special or emergency investigations, or investigations of a more difficult or complex nature, and interpreted departmental, City, State, and Federal rules and regulations for the unit staff.
  2. Determined the eligibility of applicants for medical assistance payment programs, or the ability of patients and their legally responsible relatives to pay for hospital or health care charges and take the necessary actions to bill and collect for these services.
  3. Explored alternative sources for payment of hospital or health care services rendered.
  4. Verified, modified, and coded demographic and insurance data, obtained from source documents, and accurately entered such data into computerized systems ensuring compliance with payor rules and regulations.
  5. Performed billing and collection functions; completed and/or reviewed paper and electronic claims for proper and timely submission to insurance carriers.
  6. Followed up with insurance carriers, employers, and/or patients for prompt payments; monitored and tracked denials and underpayments received from insurance carriers; completed non-clinical appeals when necessary.
  7. Escalated accounts to supervisor in a timely manner in order to obtain maximization of a hospital’s or health care facility’s revenue. 
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelor's Degree in Healthcare Administration

Hospital Care Investigator Resume

Headline : As a Hospital Care Investigator, responsible for informing the patient of health care setting rates; performing in-depth interviews with patients, families, relatives, and friends in an office setting or the health care setting, during field investigations, and/or by telephone to determine patients and/or legally responsible relatives ability to pay for services rendered.

Skills : Care Investigator, Guest Services.

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Description :

  1. Contacted outside agencies, organizations, insurance carriers, and employers to obtain necessary information about potential sources of revenue.
  2. Facilitated processing of patients’ applications for third-party benefits, including but not limited to Medicaid and Medicare.
  3. Reviewed patient account records to ensure patients were properly billed.
  4. Responded to complex inquiries from patients and third-party payers and resolved disputes concerning bills submitted for payment.
  5. Maintained statistical records and prepared status reports, interacted with other departments to identify patient status determinations and changes.
  6. Referred accounts requiring escalation to the Supervisor in a timely manner.
  7. Met all compliance standards, and requirements such as annual physical evaluation, assessments, and mandatory in-service and customer service.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Junior
Education
Education
Bachelor's Degree in Healthcare Administration

Professional Hospital Care Investigator Resume

Summary : As a Professional Hospital Care Investigator, responsible for following up on collections to ensure the maximization of revenue, performing in-depth interviews with patients and/or legally responsible relatives to determine their ability to pay for services rendered.

Skills : Merchandising, Loss Prevention.

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Description :

  1. Acted as a liaison between patients and various hospital departments and outside agencies; such as Social Security and Human Resources Administration.
  2. Conducted assessments and provided referrals to government-funded programs; such as the Cancer Services Program and Healthy Women Partnership.
  3. Facilitated revenue by processing Medicaid applications and Fee Scales timely.
  4. Responded to inquiries from patients and third-party payers and resolved disputes concerning claims submitted for payment.
  5. Prepared for your test by allowing you to take practice exams in the subjects you need to study. 
  6. Provided hundreds of questions and answers in the areas that will likely be covered on your upcoming exam, including but not limited to; Supervisory problems and techniques; Techniques of interviewing and investigation; Staff development; Preparation of records and reports.
  7. Maintained professional attire in the workplace, as well as off-site when conducting business on behalf of the Central Brooklyn Network.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor's Degree in Healthcare Administration

Hospital Care Investigator Resume

Objective : As a Hospital Care Investigator, responsible for communicating patient incidents or high-risk complaints to the compliance manager, and screening uninsured hospital patients to determine eligibility for federal, state, and county medical or disability assistance.

Skills : Product Promotion, Cash Register Operations.

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Description :

  1. Responsible for interviewing applicants and explaining the scope of different available benefits, responsible for using computer-aided guidance packages such as skills assessment tools, career planners, psychometric tests, and personal inventories.
  2. Responsible for assisting clients in determining strengths and weaknesses.
  3. Responsible for following guidelines when reviewing applicant data to determine eligibility for economic assistance.
  4. Responsible for reviewing applications for different aid programs and determining which qualification criteria for individuals.
  5. Responsible for selecting qualified applicants to refer to employers for possible job placement purposes.
  6. Responsible for writing job orders from employers to record accurate descriptions of required job duties, working hours, and wages.
  7. Responsible for communicating with people from various cultures and backgrounds on the application process.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelor's Degree in Healthcare Administration

Hospital Care Investigator Resume

Summary : As a Hospital Care Investigator, responsible for sorting out jobs relevant to the interests of candidates to forward information to candidates, developing strong communication and organizational skills through working on group projects, and also gaining strong leadership skills by managing projects from start to finish.

Skills : Inventory Control, Hospital Care Management.

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Description :

  1. Verified insurance eligibility and benefits for patients requesting Advanced Imaging Services.
  2. Conducted comprehensive System Checks for the uninsured population, and documented notation in Epic.
  3. Submitted online authorization requests via a medical benefits management company and ensured financial clearance.
  4. Facilitated public health insurance screening and enrollment for uninsured populations.
  5. Updated demographic, biographic, and insurance information in patient accounting/revenue cycle systems.
  6. Provided daily productivity reports, informs patients of appointments, conducts patient interviews, and follows
  7. Advanced Imaging workflow guidelines, logged into EPIC to view the accounts assigned to you on your work queue and other work queues specified by leadership and/or the leader assigning cases for the day.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor's Degree in Healthcare Administration

Hospital Care Investigator Resume

Headline : As a Hospital Care Investigator, responsible for organizing and detail-orienting with a strong work ethic, working effectively in fast-paced environments, and checking the Media Manager for insurance cards and documents that may have insurance information listed or other pertinent information that would be beneficial and would aid in verifying coverage (SSNs, out of state IDs, Ambulance/EMS Reports, transfer documents).

Skills : Reporting, Organizational Skills.

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Description :

  1. Followed up with interview upon receiving into your EPIC work queue and make a second interview attempt.
  2. Prepared interview package with all forms that require signatures to complete Medicaid applications and to bill insurance.
  3. Interviewed patients without insurance (true self-pay) based on an assessment or patient's request to complete a Medicaid application via NYSOH (assess for disability MA application/Surplus prior to submitting via NYSOH) or Bluemark. 
  4. Created Medicaid Application Financial Tracker, interviewed patients, and made sure to verified demographic information. 
  5. Created a Finance Assistance Case after the interview had been conducted, and created Financial Trackers as necessary.
  6. Interviewed patients, family members, and friends to determine the source of payment for services rendered.
  7. Explored sources of hospital reimbursements Medicare, Medicaid, Hospital insurance university or private special programs- No Fault, MVAIC, Workers Compensation, and Self Pay.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Bachelor's Degree in Healthcare Administration