Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.

Responsible for multiple components of the complex coding process for specialized procedures, including Accounts Receivable, Charge Entry, Edits, Work queues, Denials, and Payment Posting. Facilitates claims processing and payments services rendered by physicians. Assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures due to medical necessity. Coordinates activities related to data entry of billing. Demonstrates proficiency in analysis and problem resolution to ensure accurate and timely coding of claims and collection. Works directly with the Department Administrator. Reports to Practice Administrator/Revenue Cycle Director.

Roles and Responsibilities:

• Manages and accurately codes outpatient encounters diagnosis, procedures and/or modifiers that are supported by the health record in accordance using ICD-10-CM/PCS, CPT and HCPCS coding conventions.

• Enters office, inpatient, and/or outpatient charges with accurate data entry of codes. Ensures charges are entered/processed in accordance with policies and procedures.

• Extract CPT codes form operative reports, reconcile with CPT codes authorized and the provider’s bill, to ensure optimal coding.

• Collaborate with other coders and provide education/feedback to the providers on optimal billing and coding for outpatient encounters, in-patient consults and procedures/surgeries.

• Provide orientation to the new providers about relevant billing and coding for neurosurgical encounters.

• 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.

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

• Queries and/or submits request to the physician for additional information or clarification of diagnoses, co-morbid/secondary conditions, and procedures. Assures coding practices fall within established compliance guidelines.

• Assists with reviews of billing denials.

• Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.

• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately. Reviews encounter forms for accuracy.

• Posts necessary charge codes for billing in Epic Runs and works missing charges, edits, denial lists and processes appeals.

• Provides comprehensive pre-billing management to front end teams, faculty practices, and surgical coordinators. Tracks, quantifies and reports on denied claims.

• Directs and assists with responses to problems or questions regarding medical necessity for office visits, in-patient consults and procedures.

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

• Meets with practice management, leadership and/or physicians on a scheduled basis to review current billing and coding concerns.

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

• 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.

Education:

• Associates Degree or high school diploma/GED

• Certification: Coding certification required

Experience:

• 1+ years’ experience in neurosurgical coding strongly desired.

• Familiarity with Epic preferred medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding.

Licensing and Certification Requirements

• Certification: Certified coder – required (CPC preferred)

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity and inclusion are drivers 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 medicine together and participate actively as a leader within the Mount Sinai Health System by:

• Serving as the primary resource management representative of the Mount Sinai leadership teams, committees, etc., and acting as the primary executive leader interface between Mount Sinai and key executives from the health systems’ vendors and partners.

• Engaging with relevant thought leaders and policy-makers at the federal and state levels, and representing the Health System as assigned.

• Using a lens of equity in establishing and promoting policies and procedures and providing opportunities for all to thrive.

• Confronting racist, sexist or other inappropriate behavior and challenges exclusionary organizational practices and serving as a role model to promote anti-racist behaviors.

• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

We work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make 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 42,000 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 hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside (formerly 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 comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression.

EOE Minorities/Women/Disabled/Veterans

Compensation

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $58,661.00 - $81,675.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.