Mount Sinai Health System · 4 hours ago

FPA Coding & Reimbursement Analyst (CPC Certification Required) - Orthopedics

United States

Full-time

Remote

Mid, Senior Level

$106K/yr - $111K/yr

5+ years exp

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Responsibilities

Performs pre-surgical diagnostic and procedural coding review for complex surgical cases including co-surgery and team cases.

Negotiates surgical reimbursement with third carrier Medical Directors. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

Manages submission of services not identified by correct coding initiative.

Reviews surgical package comprised of operative report, surgical pathology report and pre-authorization for correct coding.

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

Manages all appeals for payment review.

Studies reimbursement trends.

Educates Financial Specialists, Billing Coordinators and other FPA staff in coding and claims management.

Meets with Chairman, department management/leadership and physicians on a scheduled basis to review current billing concerns and updates in regulations/ relevant items.

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

Other identified duties as assigned.

Qualification

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Certified Procedural CoderMedical billing experienceCertified Professional CoderIDX billing systemsICD codingCPT codingClaims managementMentoring

Required

Bachelors degree plus 5 years of relevant experience, or equivalent combination of education and specific experience.

Certified Procedural Coder with active credentials.

5 years 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.

Certification: Certified Professional Coder (AAPC or AHIMA)