Mount Sinai Careers
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SENIOR BILLING SPECIALIST
- Implements and manages outpatient and provider coding process for inpatient and outpatient physician services.
- Validates and determines appropriate coding levels by obtaining and reviewing clinical documentation.
- Compares and reviews charge tickets, both manually and system generated, to clinical documentation to ensure that all charges for procedures and related services have been accurately documented and captured.
- Ensures that documentation supports charges to prevent denials/underpayments and to ensure adherence to compliance standards.
- Follow-up on missing charge tickets and clinical documentation as appropriate.
- Develop educational materials and policies/procedures to assist providers with the new regulatory or payer policies.
- Identifies and assists with implementation of documentation and revenue enhancement opportunities.
- Collaborates with clinical staff to identify and implement appropriate documentation and coding modifications.
- Reviews and distributes coding related information to clinical staff, including CPT and ICD-9 code changes, medical necessity policies, coding /billing information regarding new procedures and pharmacy items.
- Develops educational material and policies and procedures to assist providers with understanding new regulatory or payer policies as they relate to coding changes.
- Assists in the development of fee schedule updates.
- Responsible for resolving any coding related errors, edits and denials that are identified by the physician practices or practice billing system.
- Consults and provides feedback with front line clinical staff, administrators and financial counselors to identify reimbursable indications for treatment.
- Continuously reviews revenue cycle with management team and supervisor.
- Participates in education programs to maintain up to date coding skills.
- Participates with the Compliance Department in random chart audits to ensure appropriate documentation, coding and billing.