Denials Resolution Specialist – Hospital Billing

Mount Sinai; New York (NY); On-site; USD 65,885 - 98,827; Full time

Job summary

Mount Sinai Medical Center seeks a Denials Coordinator to manage and resolve denied insurance claims. This position involves analyzing denial trends, coordinating appeals, collaborating with various departments to prevent future denials, and maintaining compliance with regulations. Candidates should have extensive experience in healthcare revenue cycles, strong analytical skills, and proficiency in relevant billing systems. The role offers professional growth within a supportive environment in the heart of New York City.

Qualifications

• Three years of experience in healthcare revenue cycle.
• Strong knowledge of insurance policies, coding (ICD-10, CPT), and denial management systems.
• Ability to manage multiple tasks and deadlines.

Responsibilities

• Analyze denied insurance claims to understand the reasons for denial.
• Coordinate the appeals process for denied claims.
• Work with departments to implement solutions to prevent future denials.
• Maintain relationships with insurance payers for claim resolution.
• Serve as a resource for staff regarding denial issues.

Skills

Analytical skills

Communication skills

Problem-solving skills

Knowledge of billing systems

Organizational skills

Education

HS/GED; Bachelor's degree preferred

Tools

Epic Resolute hospital billing

Electronic Medical Records (EMRs)

Job description

Description

Denials Coordinator – Hospital Billing Patient Financial Services – Corporate 42nd Street – Full-Time – Days (Hybrid)

A hospitaldenial coordinatormanages and resolves denied insurance claims to help the hospital recover revenue.Key responsibilities include analyzing claim denial reasons, identifying denial trends, sharing trends and findings with owner areas, coordinating the appeals process, collaborating with departments to prevent future denials, maintaining documentation including issue logs with updates, denied dollars and resolutions, and acting as a resource for staff regarding denial-related issues and payer rules. This person will escalate issues to management if deadlines are missed, payer responses are not received, or when barriers or process gaps are identified.

Responsibilities

• Analyze Denials:
  • Review and investigate denied insurance claims to understand the specific reasons for denial
• Appeal Management:
  • Initiate, track, and coordinate the appeals process for denied claims, ensuring all necessary documentation and timely follow-up are completed.
• Trend Identification:
  • Analyze denial data to identify patterns and root causes of denials and underpayments.
• Process Improvement:
  • Work with various hospital departments (e.g., coding, billing, clinical) to develop and implement solutions to prevent future denials and improve processes
• Payer Relations:
  • Maintain relationships with insurance payers to facilitate claim resolution and address ongoing issues.

• Documentation and Reporting:

  • Maintain accurate records of all denial and appeal activities, including logs and system records, and prepare reports for management on denial trends.This includes routine report outs of identified trends, next steps, resolutions or barriers to resolution
• Resource:
  • Serve as a point of contact for staff questions regarding denial rationale, timely filing, payer policies, and the appeals process
• Compliance:
  • Ensure adherence to regulatory compliance, such as HIPAA, and stay informed about payer and Medicare/Medicaid guidelines.

Qualifications

• HS/GED; Bachelors degree preferred
• Three years of experience within hospital healthcare revenue cycle, performing administrative or process improvement type functions
• Strong knowledge of Epic Resolute hospital billing
• Knowledge of healthcare revenue cycle, insurance policies, coding (ICD-10, CPT), and denial management systems.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills to collaborate with internal teams and external payers.
• Ability to organize and manage multiple tasks and deadlines.
• Proficiency with relevant software and databases, including Electronic Medical Records (EMRs).

Non-Bargaining Unit, 518 - PFS 633 Third Avenue - MSH, Mount Sinai Hospital

Employer Description

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

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $66482.07 - $98827 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.