Clinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days-Hybrid

Clinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days-Option to work remote or hybrid.

The Clinical Revenue Auditor for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) (which includes the MSHS and the Faculty Practice Plan) is responsible for reviewing and verifying that all billable services and procedures provided to patients are accurately documented, coded, and submitted for payment. This position plays a key role in ensuring the financial health and compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position will report to the Senior Director CDM of the Mount Sinai Health System

This role will serve as a crucial link in the revenue cycle, ensuring that patient care translates into accurate and timely reimbursement, safeguarding the financial well-being of the organization and contributing to improved patient care standards. This role requires a unique blend of clinical expertise and financial acumen to ensure compliance with healthcare regulations and collaborate with staff to resolve issues and provide education.

• Conduct thorough charge capture/clinical audits to assess the effectiveness of the billing process.
• Identify and rectify missing or incorrect charges, coding errors, and inconsistencies between documentation and billing.
• Perform root cause analysis to understand the underlying issues contributing to revenue leakage and develop corrective action plans.
• Optimize revenue capture by ensuring all billable services are appropriately charged, ultimately maximizing reimbursement for services rendered.
• Ensure adherence to coding guidelines and compliance regulations set by entities like the Centers for Medicare and Medicaid Services (CMS).
• Mitigate the risk of compliance violations, audits, and potential penalties related to billing errors.
• Streamline charge capture processes to improve efficiency and reduce administrative burden.
• Collaborate with clinical, billing, coding, and IT departments to address documentation issues and optimize workflows.
• Leverage charge capture software and analytics tools to identify gaps and areas for improvement in the charge capture process.
• Coordinate with payers to ensure timely handling of audit requests, review technical payer denials, determine if an appeal is warranted, and write and track appeal letters.
• Educate clinical teams and other stakeholders on appropriate documentation and charge capture practices to promote adherence to standards and improve overall process efficiency.
• Build effective, collaborative relationships with key stakeholders across departments.
• Resourceful in creating or fine-tuning the processes necessary to complete the work along with the ability to organize people and activities.
• Challenge existing norms or courses of action to facilitate fully informed decision-making. Help institute balanced decision-making by identifying risks and opportunities.
• Establish and maintain strong working relationships with revenue cycle leaders, key stakeholders, and foster a strong working relationship with key strategic partners.
• Create feedback loops and enhancement pipelines informed by stakeholders and data.
• Ensure compliance with all HIPAA privacy and security standards.Conform to the established policies/ procedures/ processes/ Standards of Behavior.
• Performs other duties as required by the Senior Director of CDM

Education                                         
?    Bachelors in an applicable healthcare-related profession; Masters is preferred

Experience                                         
?    3-5 years of clinical experience is required. Key skills include a strong understanding of medical terminology and patient care, expertise in medical coding systems and healthcare regulations, analytical and problem-solving abilities, excellent communication skills, and proficiency with EHR systems and audit software. Attention to detail and ethical judgment are also important.
?    Demonstrated success in a large not-for-profit/academic health system facility or multi-entity revenue cycle environment.
?    Extensive knowledge of medical billing software and electronic medical records.  Must have experience working with Epic.
?    Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, etc.), managed care contracts and coordination of benefits is required. Working knowledge of medical terminology, and medical record coding experience are highly desirable.
?    Excellent interpersonal skills and experience working with senior management and other leaders, along with the ability to communicate concepts to others.
?    Knowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care. 
?    Expected to stay updated on current medical billing and coding processes, clinical procedures, and relevant disease states.

?    Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/ or agendas, leading to outcomes that meet identified goals. 
?    Excellent verbal and written communication and organizational abilities. Accuracy, attentiveness to detail and time management skills are required. 
?    Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally.
?    The ability to maintain a high level of positive energy/creativity during periods of elevated work demands.
?    Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes.
?    Ability to develop and maintain effective relationships at all levels throughout the organization.

License               
?    Current NYS licensure (Registered Nurse (RN), Occupational Therapist (OT), Physical Therapist (PT), Speech-Language Pathologist (SLP), Physician Associate (PA), Social Worker (LMSW/LCSW), Laboratory Technologist, Radiological Technologist and related professions). 
?    Certifications such as Certified Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Healthcare Auditor (CHA) can be beneficial.

Computer Skills                                            
MS Office Suite: Intermediate  

• Work Environment
• ?    Corporate office environment in an academic health system.  Option to work remote or hybrid.

, 518 - PFS 633 Third Avenue - MSH, Mount Sinai Hospital

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.