Mount Sinai Medical Center of Florida, Inc.
Revenue Cycle Audit Manager
Mount Sinai Medical Center of Florida, Inc., Miami, Florida, us, 33222
Revenue Cycle Audit Manager page is loaded## Revenue Cycle Audit Managerlocations:
Miami Beach, FLtime type:
Full timeposted on:
Posted 3 Days Agojob requisition id:
JR460445**As Mount Sinai grows, so does our legacy in high-quality health care.**Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.**Culture of Caring: The Sinai Way**Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.**Department:**CC209041 Physician Billing**Job Description Summary:**## Position 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 elimminate unncessary 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 enhacements 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 endusers.* 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 ammended 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 departamental 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 activites 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.## Qualifications* ### License/Registration/Certification
+ CPC or comparable licensure required* ### Education
+ CPC and/or CCS Certified or comparable certification; Preferred Associate degree* ### Experience
+ 5 years prior work experience in hosptial financial, coding or medical claims. Manager experience preferred.**Benefits:**We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:* 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!**Degree Requirements:****Certification:** #J-18808-Ljbffr
Miami Beach, FLtime type:
Full timeposted on:
Posted 3 Days Agojob requisition id:
JR460445**As Mount Sinai grows, so does our legacy in high-quality health care.**Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.**Culture of Caring: The Sinai Way**Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.**Department:**CC209041 Physician Billing**Job Description Summary:**## Position 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 elimminate unncessary 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 enhacements 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 endusers.* 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 ammended 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 departamental 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 activites 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.## Qualifications* ### License/Registration/Certification
+ CPC or comparable licensure required* ### Education
+ CPC and/or CCS Certified or comparable certification; Preferred Associate degree* ### Experience
+ 5 years prior work experience in hosptial financial, coding or medical claims. Manager experience preferred.**Benefits:**We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:* 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!**Degree Requirements:****Certification:** #J-18808-Ljbffr