Mount Sinai Morningside ยท 5 months ago
On-Site Procedural Billing Specialist I - Orthopedics Roosevelt (West)
New York, NY
Full-time
Onsite
Senior Level
$65K/yr - $88K/yr
5+ years expMount Sinai Morningside is a prominent healthcare provider committed to delivering outstanding patient care. The Procedural Billing Specialist I is responsible for managing the complex billing and coding processes for specialized procedures, ensuring accurate claims processing and facilitating payments for services rendered by physicians.
Hospital & Health Care
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
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)
Company
Mount Sinai Morningside
At Mount Sinai Morningside, we offer exceptional clinical care and research within the comfort of a neighborhood hospital known for compassion and sensitivity.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Faye Reiff-Pasarew
Deputy CMO, Associate Chief of Hospital Medicine, Assistant Professor of Internal Medicine
Lucy Xenophon, MD, MPH
Chief Transformation Officer
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