Mount Sinai Services ยท 3 months ago
Clinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days-Hybrid
New York, NY
Full-time
Hybrid
Mid Level
$96K/yr - $145K/yr
3+ years expMount Sinai Health System is a leading academic medical institution dedicated to transforming healthcare. The Clinical Revenue Auditor will play a vital role in ensuring accurate documentation and billing of patient services, bridging clinical care and medical billing to safeguard the organization's financial health and compliance.
Health CareHospitalHospitality
Responsibilities
Conduct thorough charge capture/clinical audits to assess the effectiveness of the billing process
Identify and rectify missing or incorrect charges, coding errors, and inconsistencies between documentation and billing
Perform root cause analysis to understand the underlying issues contributing to revenue leakage and develop corrective action plans
Optimize revenue capture by ensuring all billable services are appropriately charged, ultimately maximizing reimbursement for services rendered
Ensure adherence to coding guidelines and compliance regulations set by entities like the Centers for Medicare and Medicaid Services (CMS)
Mitigate the risk of compliance violations, audits, and potential penalties related to billing errors
Streamline charge capture processes to improve efficiency and reduce administrative burden
Collaborate with clinical, billing, coding, and IT departments to address documentation issues and optimize workflows
Leverage charge capture software and analytics tools to identify gaps and areas for improvement in the charge capture process
Coordinate with payers to ensure timely handling of audit requests, review technical payer denials, determine if an appeal is warranted, and write and track appeal letters
Educate clinical teams and other stakeholders on appropriate documentation and charge capture practices to promote adherence to standards and improve overall process efficiency
Build effective, collaborative relationships with key stakeholders across departments
Resourceful in creating or fine-tuning the processes necessary to complete the work along with the ability to organize people and activities
Challenge existing norms or courses of action to facilitate fully informed decision-making. Help institute balanced decision-making by identifying risks and opportunities
Establish and maintain strong working relationships with revenue cycle leaders, key stakeholders, and foster a strong working relationship with key strategic partners
Create feedback loops and enhancement pipelines informed by stakeholders and data
Ensure compliance with all HIPAA privacy and security standards
Conform to the established policies/ procedures/ processes/ Standards of Behavior
Performs other duties as required by the Senior Director of CDM
Qualification
Required
Bachelors in an applicable healthcare-related profession; Masters is preferred
3-5 years of clinical experience is required
Strong understanding of medical terminology and patient care
Expertise in medical coding systems and healthcare regulations
Analytical and problem-solving abilities
Excellent communication skills
Proficiency with EHR systems and audit software
Attention to detail and ethical judgment
Demonstrated success in a large not-for-profit/academic health system facility or multi-entity revenue cycle environment
Extensive knowledge of medical billing software and electronic medical records
Experience working with Epic
Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, etc.)
Knowledge of managed care contracts and coordination of benefits
Working knowledge of medical terminology
Medical record coding experience
Excellent interpersonal skills and experience working with senior management and other leaders
Ability to communicate concepts to others
Knowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care
Expected to stay updated on current medical billing and coding processes, clinical procedures, and relevant disease states
Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/or agendas
Excellent verbal and written communication and organizational abilities
Accuracy, attentiveness to detail and time management skills
Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally
Ability to maintain a high level of positive energy/creativity during periods of elevated work demands
Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes
Ability to develop and maintain effective relationships at all levels throughout the organization
Current NYS licensure (Registered Nurse (RN), Occupational Therapist (OT), Physical Therapist (PT), Speech-Language Pathologist (SLP), Physician Associate (PA), Social Worker (LMSW/LCSW), Laboratory Technologist, Radiological Technologist and related professions)
Preferred
Certifications such as Certified Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Healthcare Auditor (CHA) can be beneficial
Knowledge of medical record coding experience are highly desirable
Company
Mount Sinai Services
Mount Sinai Services is a hospital & health care company located in Toronto.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase