Health Plan Claims Analyst I - Pyschiatry

Strength Through Diversity Ground breaking science. Advancing medicine. Healing made personal. The Health Plan Claims Analyst I is responsible for multiple components of specific health plan operations. He/she is responsible for providing administrative, operational and programmatic support services of within an assigned area/department. This position requires strong problem solving skills, analytical and organizational abilities, and involves making recommendations to program leadership for quality improvement. The position will also require coordination of workflow across multiple entities including payors, providers, and program leadership and therefore also requires effective communication. Roles & Responsibilities: Trains and orients new staff on program policies and procedures. Conducts quality assurance for the team and proposes areas for process and quality improvement. Guides a wide range of network providers on the enrollment process for the WTC Health Plan, includes providing education on health plan rules and claims processing process Conducts presentations on the World Trade Center Health Program rules, authorization process, documentation requirements, and clinical center review process to various stakeholders including providers and clinical center personnel Reviews requested medical documentation from program sponsor and presents required information to medical review team along with applicable guidelines, supports medical review team with administrative review Reviews claims information for quality assurance purposes, makes recommendations for process improvement or changes in documentation or workflow. Escalates ongoing payment challenges with program leadership and program sponsor; may present solutions to leadership and sponsor as well Reviews and approves claims for patients under the WTCHP. Appropriately documents claim decisions (e-Claims portal) and reviews approval and denial patterns Maintains a working knowledge of World Trade Center Health Program coverage and payment guidelines, monitors changes in coverage and notifies program leadership of changes. Identifies and communicates and provides possible solutions on billing issues and patterns to program leadership. Maintains liaison with staff in other departments to coordinate program activities and training to accomplish program objectives, and to ensure cooperative efforts are enhanced and available resources are utilized. Ensure that changes to the health plan protocols are communicated and included in program updates and educational seminars. Recommends new ideas and concepts for program themes, materials and resources to supplement, expand or replace existing program components. Works with program leadership to develop the content of these materials Other duties assigned as needed. Requirements: Bachelor's Degree preferred or Associates Degree with 5 years of relevant experience 5 years' experience in medical billing or health claims, with experience in EPIC billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding. Strength Through Diversity The Mount Sinai Health System believes that diversity, equity and inclusion are drivers for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together and participate actively as a leader within the Mount Sinai Health System by: Serving as the primary resource management representative of the Mount Sinai leadership teams, committees, etc., and acting as the primary executive leader interface between Mount Sinai and key executives from the health systems’ vendors and partners. Engaging with relevant thought leaders and policy-makers at the federal and state levels, and representing the Health System as assigned. Using a lens of equity in establishing and promoting policies and procedures and providing opportunities for all to thrive. Confronting racist, sexist or other inappropriate behavior and challenges exclusionary organizational practices and serving as a role model to promote anti-racist behaviors. Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers. We work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make an impact on quality patient care. Explore more about this opportunity and how you can help us write a new chapter in our story! Who We Are Over 42,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve. Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside (formerly Mount Sinai St. Luke’s), and New York Eye and Ear Infirmary of Mount Sinai. 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. EOE Minorities/Women/Disabled/Veterans Compensation The 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 $58,661.00 - $81,675.00 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.