Senior Medical Billing Specialist – Complex Surgical Claims

Mount Sinai; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Mount Sinai Health System seeks a skilled Medical Billing Specialist to support complex pre and post-surgical coding, A/R, and payment posting. You will collaborate with physicians and Insurance teams to ensure accurate claims and timely cash flow.

The role requires IDX experience, strong ICD/CPT knowledge, and a track record of mentoring junior staff within a hospital billing environment. On-site at New York locations, you will advance patient financial services and payer negotiations.

Qualifications

• 7 years in medical billing or health claims with IDX experience.
• Familiarity with ICD/CPT coding, preferably for specialized surgeries.
• CPC strongly preferred; Oncology experience advantageous.
• Proficiency in MS Office and computerized billing methods.

Responsibilities

• Perform specialized coding for complex inpatient/outpatient visits.
• Provide financial counseling; discuss payment options with patients.
• Explain insurance coverage and out-of-network implications.
• Develop and manage self-pay fee schedules.
• Process workers' compensation claims and resolve discrepancies.
• Negotiate with insurers and medical directors to optimize payments.
• Manage appeals processes for claims as needed.
• Verify insurance data and pre-certifications for procedures.
• Enter and oversee charges for office and hospital services.
• Post payments in IDX; run missing charges and denials reports.
• Provide denial management to support cash flow.
• Respond to questions regarding eligibility and reimbursement.
• Research unidentified or misdirected payments.
• Monitor credit balances to ensure regulatory compliance.
• Analyze claims reports to identify underpayments and recoveries.
• Resolve credentialing issues for department physicians.
• Meet with leadership to review AR and billing concerns.
• Mentor junior staff; support Billing/Revenue Cycle Manager.
• Maintain up-to-date reimbursement knowledge.

Skills

Medical billing

Excellent organizational skills

Excellent communication & customer

Attention to detail

Analytical & research abilities

ICD/CPT coding knowledge

Education

CPC (Certified Professional Coder)

Tools

IDX billing system

MS Office Suite

Computerized medical billing training

Job description

Mount Sinai Health System seeks a skilled Medical Billing Specialist to support complex pre and post-surgical coding, A/R, and payment posting. You will collaborate with physicians and Insurance teams to ensure accurate claims and timely cash flow.

The role requires IDX experience, strong ICD/CPT knowledge, and a track record of mentoring junior staff within a hospital billing environment. On-site at New York locations, you will advance patient financial services and payer negotiations.