Specialty Collector Healthcare

As Mount Sinai grows, so does our legacy in high-quality health care.Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.Culture of Caring: The Sinai WayOur hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.Department:CC209041 Physician BillingJob Description Summary:The Specialty Collector is responsible for researching and resolving complex physician billing accounts, with a primary focus on underpaid claims, reimbursement variances, managed care payment accuracy, and payer payment discrepancies. This position compares payer payments against contracted reimbursement rates, investigates variances, pursues corrected reimbursement, and identifies payer trends that may affect financial performance.Position ResponsibilitiesResearches underpaid claims and compares payer reimbursements against applicable contracted reimbursement rates to identify payment variances and recovery opportunities.Reviews managed care payments for accuracy and investigates discrepancies between expected and actual reimbursement.Identifies and investigates payer processing errors, reimbursement discrepancies, and claim adjudication issues affecting payment.Initiates and escalates reimbursement disputes when applicable and pursues corrected payments, claim reprocessing, and retroactive adjustments.Identifies recurring underpayment and reimbursement trends that may impact financial performance and communicates findings to leadership and appropriate departments.Documents and tracks underpayment opportunities and recovered reimbursement to support monitoring of collection outcomes and financial impact.Works assigned Epic Physician Billing work queues to investigate and resolve claim issues, denials, and outstanding balances.Prepares and submits first- and second-level appeals as appropriate and follows submitted appeals and deferred claims through resolution.Utilizes payer portals, including SPOT when applicable, and communicates with insurance payers to research claim status, reimbursement, eligibility, and payment issues.Reviews medical records and supporting documentation, when necessary, to support claim reconsiderations and appeals.Maintains clear and accurate account documentation describing the issue identified, research performed, actions taken, and required follow-up.Collaborates with department leadership and other appropriate departments to resolve complex reimbursement and claim-related issues.Prioritizes assigned work to maximize productivity, accuracy, and timely resolution while minimizing backlogs.Participates in departmental education, team discussions, and special collection or reimbursement projects as assigned.Demonstrates initiative in maintaining knowledge of payer requirements, managed care reimbursement, Epic workflows, denials, appeals, and physician billing collection practices.QualificationsEducationHigh School Graduate or equivalent level of training.ExperienceMinimum of one year of healthcare collections experience.Knowledge of managed care benefits and payer requirements, including PPO, POS, HMO, Medicare, and Medicaid.Experience with physician billing, claim research, denials, reimbursement discrepancies, or payer payment issues preferred.Epic Physician Billing experience preferred.Knowledge, Skills & AbilitiesKnowledge of healthcare reimbursement, collections, claim adjudication, denials, and appeals.Strong analytical and problem-solving skills with the ability to identify reimbursement variances and underpayments.Ability to research complex accounts and interpret payer and reimbursement information.Strong organizational, documentation, communication, and follow-up skills.Ability to work independently and collaboratively while maintaining productivity and accuracy.Benefits:We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:Health benefitsLife insuranceLong-term disability coverageHealthcare spending accountsRetirement planPaid time offPet InsuranceTuition reimbursementEmployee assistance programWellness programOn-site housing for select positions and more!Degree Requirements:Certification: #J-18808-Ljbffr Mount Sinai Medical Center