Mount Sinai Careers

PROCEDURAL BILLING SPECIALIST III - OTOLARYNGOLOGY

New York, New York
Professional / Managerial / Administrative


Job Description

The Mount Sinai Health System
 
Department of Otolaryngology – 2273534
 
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The Mount Sinai Health System’s commitment to excellence extends beyond delivering world-class health care. The System’s ongoing success is dependent upon our highly motivated, nonclinical professionals working to improve business operations. Our leadership team is driven to provide exceptional service by cultivating a workforce that is dedicated to upholding Mount Sinai’s mission of delivering innovative, breakthrough medicine with compassion and integrity.
 
Are you ready to discover the world of limitless possibilities that comes with wearing the badge? Explore more about this opportunity and how you can help us write a new chapter in our story of unrivaled patient care!
 
 
What You’ll Do:
 

The Procedural Billing Specialist III is a senior level individual, responsible for multiple components of the billing process for specialized or complex pre and post-surgical procedures, including coding, Accounts Receivable, Charge Entry, Edits and Payment Posting. Facilitates claims processing for services rendered by physicians. Assists with responses to problems or questions on benefit eligibility and reimbursement procedures. Independently engages or participates in the negotiation process with third party carrier Medical Directors and other representatives. Coordinates activities related to data entry of billing; performs staff training. Demonstrates proficiency in analysis and problem resolution to ensure accurate and timely payment of claims and collection. Maintains open dialogue with the Department Administrator or Manager on billing activity and current concerns.

Duties and Responsibilities:

 

  • Performs specialized coding services for complex or more specialized inpatient and outpatient medical office visits. Reviews physician coding and provides updates.
  • May provide financial counseling to patients, discussing the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations. Develops and manages fee schedules and for self pay patients.
  • Identifies submitted and required documentation to maximize revenue capture.
  • Processes Worker’s Compensation claims and addresses/resolves all discrepancies.
  • Conducts specialized negotiations with insurance companies, including engagement with Medical Directors and other relevant parties. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.
  • Manages or participates in the appeals process for claims as required.
  • Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.
  • Enters or oversees the accurate entry of office, inpatient, and/or outpatient charges. Runs and works missing charges, edits, denials list and processes appeals. Posts denials on a timely basis.
  • Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.
  • Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.
  • Works credit balance report to ensure adherence to government regulations/guidelines.
  • Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations. Researches unidentified or misdirected payments.
  • Identifies and resolves credentialing issues for department physicians.
  • Reviews and distributes coding-related information to clinical staff, including CPT and ICD-9/10 code changes, medical necessity policies, coding/billing information on new procedures and devices.
  • Trains and mentors less experienced billing staff. Assists area Manager in staff training initiatives.
  • Maintains currency in profession on reimbursement trends, coding updates, etc.
  • Other duties as assigned.

 

What You’ll Bring:
 

Education:

Associates Degree, or high school diploma/GED.

Experience:

10 years experience in medical billing or health claims, with experience in billing systems in a health care or insurance environment, and familiarity with CPT/ ICD-9/10 coding, preferably in specialized and complex surgical procedures.

CPC Preferred

Excellent organizational skills

Excellent communication and customer service skills

Knowledge of medical terminology and anatomy

Strong attention to detail and ability to multitask

Excellent calculation, verbal and communication skills

Strong ability in analysis and research

 
Strength Through Diversity
 
The Mount Sinai Health System believes that diversity is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize medicine together.
 
We work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make an impact on quality patient care. Explore more about this opportunity and how you can help us write a new chapter in our story! 
 
 
Who We Are:
 
Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
 
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
 
The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation. 
 
EOE Minorities/Women/Disabled/Veterans