Procedural Billing Specialist I - Surgery

Job Description

The Procedural Billing Specialist I is responsible for multiple components of the complex billing and coding process for specialized procedures, including Accounts Receivable, Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures. S / he coordinates activities related to data entry of billing, and demonstrates proficiency in analysis and problem resolution to ensure accurate and timely payment of claims and collection. The Specialist works directly with the Department Administrator. Reports to Billing Manager / Revenue Cycle Manager.

Qualifications

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

Surgery Accounts Receivable experience strongly preferred

EPIC experience strongly preferred

Experience working in a large academic medical center strongly preferred

Licensing : None but CPC strongly preferred (required in Oncology)

Non-Bargaining Unit, 862 - Surgery - ISM, Icahn School of Medicine

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.

About Us

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 Statement

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 $64526.72 - $87505.56 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.