Mount Sinai Medical Center ยท 15 hours ago
Revenue Cycle Audit Manager
Miami Beach, FL
Full-time
Onsite
Senior Level
5+ years expMount Sinai Medical Center is committed to providing high-quality healthcare and is seeking a Revenue Cycle Audit Manager. This role involves managing audit activities, ensuring compliance with billing requirements, and collaborating with various departments to improve documentation and revenue integrity.
Health CareHealth DiagnosticsMedical
Responsibilities
Manages activity of Auditors including Business Office review requests to ensure Audit Team's resources are utilized effectively. Researching root cause and educating end users. Proactively communicates with Business Office management to eliminate unnecessary requests
Oversees that all Medical Audit & Revenue Integrity WQ in Epic are worked concurrently with no longer than 7 days with no activity. Provide support to the team if short staffed
Communicates and escalates any cases to BO or Charging Departments as needed. Working together to improve workflow and provides education to ancillary departments throughout the hospital to ensure appropriate documentation, charge entry and billing
Ensures documentation accurately supports medical necessity and coding, if necessary queries physician and/or coder so that documentation and/or coding is accurate
Collaborates with MSMC Physician Practices and other clinical areas (CCC, Rad Onc, Radiology) as appropriate to recommend system or process enhancements that can improve concurrent documentation or required diagnostic testing to ensure medical necessity is met for services rendered
Maintains an open communication with the Epic teams for any changes or updates to the system that can impact or improve the daily activity of the auditors or charge entry end users
Evaluates record abstracting accuracy in conjunction with charges based on documentation and communicates with HIM leads and managers to provide feedback
Manages Medicare & Non Medicare denials and appeals ensuring timely submission of all levels of appeals. Coordinates with all necessary staff on mailed or telephone appeals and assists directly with appeals when necessary. (Ex: Claim denials, RAC, CERT, SMRC, TPE and OIG)
Periodically monitors CMS transmittals for updated and/or amended billing and coverage guidelines that can impact or revenue. Communicating with Audit Team ensuring we are current with guidelines and provides these resources to hospital departments as needed
Collaborates with the Business Office on Medicare & Non Medicare payment denials/ rejections to ensure billing is accurate. Reviews billing/coding requirements including NCDs, LCDs, and other guidelines to achieve claim resolution
Is the CDM coordinator for all department questions and requests for charges. Using CDM policy and resources from Craneware in the IT department to analyze and update charges as necessary with the approval of AVP, Revenue Integrity & VP of Finance
Reviews all Medicare accounts with high cost implants or drugs pre-billing to ensure compliance with LCD/NCD regulations. Requests additional or outside medical records as appropriate and queries coders and/or physicians if necessary
Evaluates high cost implant warranty criteria pre-billing and ensures any devices that may be qualified for warranty claim are sent to manufacturer for evaluation. Works with physicians office, servicing department and billing team to ensure that proper procedure is followed on device billing
Assists admitting nurses with medical necessity review of high cost implants or procedures prior to date of surgery as necessary. Follows cases to ensure proper documentation and coding
Conducts periodic departmental focused audits to validate charge capture and evaluate for any revenue opportunities
Manages and provides reports of ongoing or focused audits performed in the Revenue Cycle Audit department
Identifies loopholes and/or weaknesses in contract language as it pertains to audit functions and provides feedback to Managed Care Contracting and all departments with rights to release medical records
Manages all coding and charge audit requests from Non Medicare Payers and their vendors. Keeping in compliance with agreed contract language and responding in timely fashion to prevent any unnecessary take backs. Forwards any completed audits to the appropriate parties for determinations of findings
Maintains an open communication with Waystar on late charge findings and makes changes to any updates to our charging practice. Oversees that the accounts on Waystar are working timely and end users are educated on findings. Reports any changes or updates to Director/AVP as needed
Maintains an open communication with Craneware on their functions for charge master maintenance and online toolkit access. Keeps abreast of all resources provided within their system. Reports any changes or updates to Director/AVP as needed
Supports the Documentation Integrity Team with Epic process implementation and on-going improvement. Compiles Epic reports and data-mining as appropriate
Responsible for the daily operations of the revenue cycle audit staff, schedules, assignments and accuracy of their work
Collaborates with Director/ AVP on establishing short and long term goals for the department that are compatible with facility strategic plans by using data and report analysis. Coordinates revenue cycle audit operation and activities with the goal to maintain and improve the hospitals revenue cycle
Maintains current status of Coding Credentials, by annually submitting proof of compliance with AAPC or AHIMA requirements. Maintains up to date knowledge of regulatory changes impacting coding requirements and ensures that staff is appropriately educated
Qualification
Required
CPC or comparable licensure required
5 years prior work experience in hospital financial, coding or medical claims
Maintains current status of Coding Credentials, by annually submitting proof of compliance with AAPC or AHIMA requirements
Maintains up to date knowledge of regulatory changes impacting coding requirements and ensures that staff is appropriately educated
Preferred
CPC and/or CCS Certified or comparable certification
Preferred Associate degree
Manager experience preferred
Benefits
Health benefits
Life insurance
Long-term disability coverage
Healthcare spending accounts
Retirement plan
Paid time off
Pet Insurance
Tuition reimbursement
Employee assistance program
Wellness program
On-site housing for select positions and more!
Company
Mount Sinai Medical Center
Mount Sinai Medical Center provides healthcare services, including cardiology, neurology, orthopedics, endocrinology, and gastroenterology.
1001-5000 employees
H1B Sponsorship
Mount Sinai Medical Center has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (27)
2024 (28)
2023 (19)
2022 (12)
2021 (3)
2020 (6)
Funding
Current Stage
Late StageLeadership Team
Gino Santorio
President & CEO
wendy stuart
Chief Nursing Officer, Senior Vice President,
Recent News
HealthCareIT News
2025-11-26
2025-11-18
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