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Mount Sinai Health Systemposted about 2 months ago
$65,885 - $98,827/Yr
Mid Level
New York, NY
Hospitals
Resume Match Score

About the position

This role's primary focus is on assisting Mount Sinai Health Partners, FPA Departments, Network Practices, and Revenue Managers, with key aspects of contract reimbursement analysis including: reporting, cpt and work rvu(Wrvu) analysis, payer policy communication, compliance, and problem resolution. This role strengthens and maintains the system-led approach towards contract reimbursement resolution to increase collections and advise all stakeholders within MSHS.

Responsibilities

  • Support the collaboration between CBO and MSHP IPA, to provide routine data and analytics in all aspects of professional managed care contracting issues.
  • Maintain payer escalation tracker to monitor status of all projects received by managed care.
  • Function as managed care SME for the central billing office by staying up to date on NYS regulatory laws, managed care payer policies, contract language, contract negotiations, CMS fee schedule updates, claims submission and appeals, claims adjudication and coverage policies, as well as billing/coding changes.
  • Participate in regular operations calls with MSHP, payers to proactively discuss issues that may impact our contracts, specifically from a revenue perspective, progress on ongoing issues, as well as notification of payer changes such as new or terminating plans.
  • Collaborate and facilitate all escalated managed care issues received from CBO management, employed providers and/or their designees, includes Vice Chairs, department leads, revenue managers, network practice staff, Med Staff- Delegated Credentialing, ensuring prompt resolution of issues and maximizing revenue.
  • Collaborate with internal CBO teams on payer education.
  • Attend internal meetings as required e.g. team meeting, and department staff meetings.
  • Collaborates on escalated revenue cycle initiatives and operational processes with a financial impact.
  • Support and participate in different areas of payer escalation such as; settlements, denial resolution, and all other dispute resolution processes.

Requirements

  • Bachelor's degree or equivalent education and experience
  • Minimum of eight years of revenue cycle experience.
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