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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.
- 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
- Education: Associates Degree or high school diploma/GED
- Certification: CPC strongly preferred (required in Oncology)
- Experience: 5 years of 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
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.