FPA Coding & Reimbursement Analyst (CPC Certification Required) - Orthopedics

Job Description Responsible for all components of diagnostic and procedural coding review for complex pre and post-surgical procedures. Negotiates reimbursement with third party carrier Medical Directors and insurance representatives. Manages the post-payment review process. Demonstrates proficiency in analysis and problem resolution, ensuring accurate and timely payment of claims and collection. Provides education and guidance on coding and claims management to billing and other FPA staff. Confers with department Chairs and other leadership on a regular basis to discuss billing/reimbursement concerns and changes in regulations. Responsibilities Performs pre-surgical diagnostic and procedural coding review for complex surgical cases including co-surgery and team cases. Negotiates surgical reimbursement with third carrier Medical Directors. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation. Manages submission of services not identified by correct coding initiative. Reviews surgical package comprised of operative report, surgical pathology report and pre-authorization for correct coding. Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims. Manages all appeals for payment review. Studies reimbursement trends. Educates Financial Specialists, Billing Coordinators and other FPA staff in coding and claims management. Meets with Chairman, department management/leadership and physicians on a scheduled basis to review current billing concerns and updates in regulations/ relevant items. Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training. Other identified duties as assigned. Qualifications Bachelors degree plus 5 years of relevant experience, or equivalent combination of education and specific experience. Certified Procedural Coder with active credentials. 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 Certification: Certified Professional Coder (AAPC or AHIMA) Non-Bargaining Unit, 845 - Orthopaedics - ISM, Icahn School of Medicine 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: 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. 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