CBO Contract Reimbursement Specialist

This role’s primary focus is on assisting Mount Sinai Health Partners, FPA Departments, Network Practices, and Revenue Managers, with key aspects of contract reimbursement analysis including: reporting, cpt and work rvu(Wrvu) analysis, payer policy communication, compliance, and problem resolution.  This role strengthens and maintains the system-led approach towards contract reimbursement resolution to increase collections and advise all stakeholders within MSHS. 

1. Support the collaboration between CBO and MSHP IPA, to provide routine data and analytics in all aspects of professional managed care contracting issues.  
2. Maintain payer escalation tracker to monitor status of all projects received by managed care. 
3. Function as managed care SME for the central billing office by staying up to date on NYS regulatory laws, managed care payer policies, contract language, contract negotiations, CMS fee schedule updates, claims submission and appeals, claims adjudication and coverage policies, as well as billing/coding changes.
4. Participate in regular operations calls with MSHP, payers to proactively discuss issues that may impact our contracts, specifically from a revenue perspective, progress on ongoing issues, as well as notification of payer changes such as new or terminating plans.
5. Collaborate and facilitate all escalated managed care issues received from CBO management, employed providers and/or their designees, includes Vice Chairs, department leads, revenue managers, network practice staff, Med Staff- Delegated Credentialing, ensuring prompt resolution of issues and maximizing revenue. 
6. Collaborate with internal CBO teams on payer education. Attend internal meetings as required e.g. team meeting, and department staff meetings.
7. Collaborates on escalated revenue cycle initiatives and operational processes with a financial impact.
8. Support and participate in different areas of payer escalation such as; settlements, denial resolution, and all other dispute resolution processes.

 

 

 

Bachelor’s degree or equivalent education and experience

Minimum of eight years of revenue cycle experience.      

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, rec