Health Plan Claims Analyst I-Selikoff Centers for Occupational Health

Roles & Responsibilities: 

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

• Responsible for assisting in the provider network enrollment process. 
• Responsible for maintaining and following up with all provider network agreements (PNA). Which includes communicating with patient care teams and claims team about status of PNA.
• Responsible for collecting and coordinating NIOSH medical document requests. This includes reaching out to providers for additional medical records.
• Receives and follows up with patient bills as needed when providing staff coverage.
• Receives and follows up with provider inquiries as needed. 
• Assist in reviewing and troubleshooting claim issues.
• Responsible for providing provider education.
• Responsible for reviewing claims for patients under the WTCHP. 
• Responsible for following up on medical records as needed. 
• Responsible for working with the patient care team to confirm if services are authorized.
• Responsible for appropriately documenting claim decisions (e-Claims portal). 
• Responsible for understanding standard billing guidelines 
• Responsible for understanding Program billing guidelines.
• Communicates outcome to care teams on resolution status of patient bills. 
• Communicates outcome to providers on resolution status of provider inquiries. 
• Troubleshoots ideas to resolve patient bills and provider inquiries. 
• Identifies and communicates billing issues and patterns to management as appropriate.   

• 2 years experience in medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding
• Medical Coding certification required 

 

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