Mount Sinai Careers
PROCEDURAL BILLING SPECIALIST I - SURGERY
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Procedural Billing Specialist l - Surgery
Responsible for multiple components of the complex coding process for specialized procedures, including Accounts Receivable, Charge Entry, Edits and Payment Posting. Facilitates claims processing and payments services rendered by physicians. Assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures due to medical necessity. Coordinates activities related to data entry of billing. Demonstrates proficiency in analysis and problem resolution to ensure accurate and timely coding of claims and collection. Works directly with the Department Administrator. Reports to Billing Manager/Revenue Cycle Manager.
Roles & Responsibilities:
Manages and accurately codes outpatient encounters diagnosis, procedures and/or modifiers that are supported by the health record in accordance using ICD-10-CM/PCS, CPT and HCPCS coding conventions.
Abstracts, codes and assigns necessary demographic and clinical data elements required for outpatient records into Epic EMR.
Performs specialized coding services for outpatient medical office visits and infusion services. Reviews physician coding and provide updates.
Queries and/or submits request to the physician for additional information or clarification of diagnoses, co-morbid/secondary conditions, and procedures. Assures coding practices fall within established compliance guidelines.
Assists with reviews of billing denials from reference labs and other sources.
Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.
Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately. Reviews encounter forms for accuracy.
Posts necessary charge codes for billing in Eagle. Runs and works missing charges, edits, denial lists and processes appeals.
Provides comprehensive pre-billing management to facilitate cash flow. Tracks, quantifies and reports on denied claims.
Directs and assists with responses to problems or questions regarding medical necessity for ordered drugs and procedures.
Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues with medical necessity and provides recommendations.
Meets with practice management, leadership and/or physicians on a scheduled basis to review current billing and coding concerns.
Mentors less experienced coding and billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.
Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.
Other duties as assigned.
Associates Degree or High School Diploma/GED
Certification: CPC strongly preferred (required in Oncology)
5 years experience in medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding.
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