Healthcare Insurance Specialist - Case Management - Mount Sinai St. Luke's

Job Description

Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.

Roles & Responsibilities:

To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it reaches the responsible individuals. Must also maintain accurate record keeping via either electronic  documentation within the hospital Eagle and Canopy systems or written record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of  both internal and external correspondence.

Is cognizant of the philosophy, standards, objectives and policies of the Department and the Hospital Center.

  • Prioritizes Insurance Requests / Denials when received in the  department as per protocol
  • Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews
  • Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in Allscripts
  • Meets time frame for reviews / appeals as specified by Insurance / State & Federal regulation.
  • Enters concurrent review information for Review Nurses in  Allscripts
  • Obtains/Prepares Medical Records and other documentation for Photo Copying Service, outside 2nd party and / Discharge Appeals
  • Maintain the integrity of the Medical Record.
  • Utilizes Hospital Mainframe programs and Allscripts Systems effectively
  • Process Mail - Sort, identifies location and distribute to appropriate departments
  • Monitors Concurrent Nurse denial phone calls for UM Nurse to follow
  • Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests)
  • Support Appeals Nurse / Manager by confirming status of denials
  • Tracking status of Medical Record requests for denials to insure that they are received timely
  • Completes assignments based on priorities

  • Associate degree; applicable work experience may be considered in lieu of educational requirements.

  • Strong clerical skills required

  • Very Strong Computer skills on Excel and Word

  • Strong Communication skills  

Strength Through Diversity

The Mount Sinai Health System believes that diversity and inclusion 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 healthcare delivery together.
We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have 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 hospitals, including Mount Sinai Beth Israel, Mount Sinai 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 
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