Health Plan Claims Analyst I- Environmental Medicine

Description

The Health Plan Claims Analyst I is responsible for multiple components of specific health plan operations. He/she is responsible for providing administrative, operational and programmatic support services of within an assigned area/department. This position requires strong problem solving skills, analytical and organizational abilities, and involves making recommendations to program leadership for quality improvement. The position will also require coordination of workflow across multiple entities including payors, providers, and program leadership and therefore also requires effective communication

Responsibilities

• Guides a wide range of network providers on the enrollment process for specific health plans, which includes providing education on health plan rules and claims processing process.
• Maintains provider network agreements (PNA) and communicates with patient care teams and claims team about status of PNA's.
• Provides education to providers on Health Program rules, authorization process, documentation requirements, and clinical center review process.
• Coordinates requested medical documentation from program sponsor, ensures that documentation meets sponsored program documentation requirements and liaises between providers and medical review team.
• Reviews claims information for quality assurance purposes, makes recommendations for process improvement or changes in documentation or workflow.
• Troubleshoots incorrectly billed services and provides direct support to patient and other team members to address bills submitted by patients.
• Responds to provider inquiries regarding coverage and liaises with program sponsor/payor to bring inquiry to resolution.
• Reviews and troubleshoots medical claims payment issues.
• Reviews and approves claims for patients. Appropriately documents claim decisions (e-Claims portal).
• Works directly with the patient care team to facilitate authorization of services through the assigned area(s).
• Maintains a working knowledge of Health Programs coverage and payment guidelines, monitors changes in coverage and notifies program leadership of changes.
• Communicates outcome to care teams on resolution status of patient bills.
• Communicates outcome to providers on resolution status of provider inquiries.
• Identifies and communicates billing issues and patterns to program leadership.
• Maintains liaison with staff in other departments to coordinate program activities and training; to accomplish program objectives; and to ensure cooperative efforts are enhanced and available resources are utilized.
• Recommends new ideas and concepts for program themes, materials and resources to supplement, expand or replace existing program components.
• Other duties assigned as needed.

Qualifications

• Bachelor's Degree preferred or Associates Degree with 2 years of relevant experience
• 2 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

Employer Description

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $64526.72 - $81675 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.