Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal.
Roles & Responsibilities:
Responsible for ensuring that unpaid and
partially paid claims are resolved in an efficient and timely manner. Resolves
EOB discrepancies and researches refunds. Monitors and ensures that
collections, net, gross and days in accounts receivable targets are met.
Duties and Responsibilities:
- Follows up on submitted claims, monitors unpaid claims and resubmits claims with appropriate corrections and documentation
- Works declines and processes appeals
- Ensures that established billing targets for collections, gross, days in A/R and net collection ratios are met
- May analyze claims system reports to ensure that underpayments are correctly identified and collected from key carriers
- Works with payer and provider representatives to negotiate higher rates for claim payments
- Responds to patient and third party inquiries, researches and resolves complex claims and corrects errors
- Reviews correspondence and rejection data from insurance carriers; posts rejections and performs reconciliations
- May transfer secondary balances to appropriate financial class and provide documentation for processing the claims
- Reviews Credit Letter Sent (CLS) and transfers balance to appropriate financial class and dunning level
- Reviews, works and clears electronic and claims edits daily; summarizes and forwards non-workable edits to supervisor for resolution
- May process refunds for supervisory approval
- Prepares and submits referring physician updates and other major dictionary requests to supervisor for approval
- Mentors less experienced staff and assists Billing Manager with the training of new hires
- Maintains strictest confidentiality; adheres to all HIPAA and Federal Payor guidelines and regulations
- Performs other related duties
- Associates Degree or HS Diploma/GED plus two years of related experience
- 3 years healthcare billing experience required. Familiarity with CPT and ICD (coding and CCI edits)
- Electronic claims processing preferred
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!
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.