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 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 Billing Manager/Revenue Cycle Manager. Roles & 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. Abstracts, codes and assigns necessary demographic and clinical data elements required for outpatient records into Epic EMR. Performs specialized coding services for outpatient medical office visits and infusion services. Reviews physician coding and provide updates. 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 from reference labs and other sources. 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 Eagle. Runs and works missing charges, edits, denial lists and processes appeals. Provides comprehensive pre-billing management to facilitate cash flow. Tracks, quantifies and reports on denied claims. Directs and assists with responses to problems or questions regarding medical necessity for ordered drugs 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 Manager 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. Other duties as assigned Requirements: Associates Degree or high school diploma/GED Certification: CPC strongly preferred 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. 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: Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential. Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination. 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 an inclusive, welcoming and nurturing work environment where all feel they are valued, belong, and are able to professionally advance. We share the belief that all employees, regardless of job title or expertise, contribute to the patient experience and quality of patient care. Explore more about this opportunity and how you can help us write a new chapter in our history! 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 hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, 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 (MSHS) provides equal employment opportunity to all its employees and applicants for employment without unlawful discrimination on the basis of their actual or perceived race, creed, color, religion, national origin, sex, gender, gender expression, gender identity, age, disability, marital or parental status, sexual orientation, veteran, immigration, citizenship, or other protected status. EOE including Veterans and Disabled 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.