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Mount Sinai Health System · 5 months ago

On-Site Procedural Billing Specialist I - Orthopedics Roosevelt (West)

New York, NY

Full-time

Onsite

Mid, Senior Level

$65K/yr - $88K/yr

5+ years exp

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, and they are seeking an On-Site Procedural Billing Specialist I for their Orthopedics department. The role involves managing billing and coding processes for specialized procedures, facilitating claims processing, and providing financial counseling to patients.

Health CareHospitalMedical

Responsibilities

Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates

Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances

Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations

Develop and manages fee schedules and for self-pay patients

Processes Workers Compensation claims and addresses/resolves all discrepancies

Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation

Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions

Enters office, inpatient, and/or outpatient charges with accurate data entry of codes

Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis

Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims

Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures

Researches unidentified or misdirected payments

Works credit balance report to ensure adherence to government regulations/guidelines

Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations

Identifies and resolves credentialing issues for department physicians

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

Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns

Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training

Other identified duties as assigned

Qualification

Medical billing experienceICD/CPT codingIDX billing systemsAccounts ReceivableDenial managementFinancial counselingProblem resolutionData entryCommunication skills

Required

Associates Degree preferred

5 years experience in medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and strong familiarity with ICD/CPT coding

Licensing: None but CPC strongly preferred (required in Oncology)