CBO Appeals Analyst

Job Description

This position serves as Appeals Analyst for Central Billing Office management. Responsible for monitoring contractual allowances, analyzing and pursuing appeals opportunities with payors and networks, and reporting performance on underpaid claims.

Responsibilities

• Monitors and reports the accuracy of contract reimbursements per payor, for both under and overpaid claims.
• Reviews and analyzes data in our contract compliance tool (Contract Manager), EPIC, and payor policy detail for identified payment discrepancies.
• Verifies applicable contract lines of business by review of EOB messages, patient eligibility, and payor policy information for CBO contracted payors.
• Compiles and submits appeal files, by payor or network, by CPT / HCPCS codes, by error type, or by provider, to specified payor and monitors progress for proper reimbursement through established follow-up protocols.
• Provides contract rate analysis to CBO groups upon request.
• Provides / updates contract mapping submissions when necessary.
• Establishes and cultivates effective contacts in payor and network offices.
• Prepares Adhoc payor performance metrics detailing appeals and recoveries.
• Monitors, tracks, and corrects registration and posting errors in Contract Manager, and provides continuous feedback to management.
• Participates in team meetings to discuss ongoing trends and issues regarding the administration of managed care contracts.
• Uses feedback and experience to refine communication skills and tools for use in preparing appeal files.
• Maintains the strict confidentiality required for medical records and other protected health data.
• Participates in professional development efforts to ensure currency in managed care reimbursement trends.
• Other relevant duties as assigned

Qualifications

About Us

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by :

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally.

Explore more about this opportunity and how you can help us write a new 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 43,000 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 approximately 7,400 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 and top 20 in Cardiology / Heart Surgery, 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. 14 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.

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. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism."

EOE Minorities / Women / Disabled / Veterans