Jobs NYC

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.

Qualifications

• Bachelor’s degree or greater in related field or equivalent education/experience

• 2 years minimum of managed care experience in claims or contracts

• Advanced knowledge of Epic and Microsoft Excel

• Working knowledge of other Microsoft applications including Word, and Outlook

Responsibilities

1. Monitors and reports the accuracy of contract reimbursements per payor, for both under and overpaid claims.

2. Reviews and analyzes data in our contract compliance tool (Contract Manager), EPIC, and payor policy detail for identified payment discrepancies.

3. Verifies applicable contract lines of business by review of EOB messages, patient eligibility, and payor policy information for CBO contracted payors.

4. 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.

5. Provides contract rate analysis to CBO groups upon request.

6. Provides/updates contract mapping submissions when necessary.

7. Establishes and cultivates effective contacts in payor and network offices.

8. Prepares Adhoc payor performance metrics detailing appeals and recoveries.

9. Monitors, tracks, and corrects registration and posting errors in Contract Manager, and provides continuous feedback to management.

10. Participates in team meetings to discuss ongoing trends and issues regarding the administration of managed care contracts.

11. Uses feedback and experience to refine communication skills and tools for use in preparing appeal files.

12. Maintains the strict confidentiality required for medical records and other protected health data.

13. Participates in professional development efforts to ensure currency in managed care reimbursement trends.

14. Other relevant 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 $64761.36 - $75898.69 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.