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Hospital Care Investigator Resume Example

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HOSPITAL CARE INVESTIGATOR
Professional Summary
Currently an MBA Student, who is a detailed oriented and who is a reliable financial professional with over 5 years of experience working in the medical industry. Areas of specialization include Customer Service, interviewing, and financial reporting. I have computer skills that include: MS Word, Excel, PowerPoint, Access, Epic, Epaces, Omni, Availity, Lotus Notes, NaviNet, Oam, Edm, facets, HHS connect, and GroupWise.
Skills
  • Works well under pressure
  • Forecasting and planning
  • Driving continuous improvement
  • Fast Learner
  • Works well with teams

Work History
Hospital Care InvestigatorHarlem Hospital Center - NY, NY12/2014 - Current
  • Developed monthly reports.
  • Lower Bad Debt cases by 40%. Therefore, Revenue increased by 40%. 
  • Evaluate and investigate fraud, complaints, and billing discrepancies
  • Inform patient of hospital rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the hospital, during field investigations, and/or by telephone to determine patients' and/or legally responsible relatives ability to pay for services rendered
  • Efficiently performed insurance verification, pre-certification and pre-authorization functions for hospital billing
  • Provide excellent Customer Service to patients
Fianancial Care InvestigatorBrookdale Hospital and Medical Center - Brooklyn, NY07/2012 - 12/2014
  • Efficiently performed insurance verification, pre-certification and pre-authorization functions for hospital billing
  • Served as liaison with social services and home care agencies
  • Handled billing and payments
  • Evaluated and investigated fraud, complaints, and billing discrepancies
Eligibility AssociateFidelis Care NY - Queens, NY07/2010 - 07/2012


  • Reviewed and Submitted 30+ Medicaid, CHP and FHP applications daily
  • Processed Access New York and Child Health Plus applications according to New York State Guidelines
  • Assisted Supervisors and senior associates with generating reports, researching applications and retrieving information using FACETS
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.


Education
MBA: Adelphi University - Garden City, NYCurrent
  • Current GPA 3.75
  • Course work includes Finance, Technology and Operations Management, Leadership, Accounting, Statistics, Negotiations , Team building , Entrepreneurship and Investment Analysis and Building Shareholders Values
Bachelor of Science: Business Management Concentration HR ManagementFairleigh Dickinson University - Teaneck, NJ2010
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Resume Overview

Companies Worked For:

  • Harlem Hospital Center
  • Brookdale Hospital and Medical Center
  • Fidelis Care NY

School Attended

  • Adelphi University
  • Fairleigh Dickinson University

Job Titles Held:

  • Hospital Care Investigator
  • Fianancial Care Investigator
  • Eligibility Associate

Degrees

  • MBA :
    Bachelor of Science : Business Management Concentration HR Management

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