Health Plan Claims Analyst I- Environmental Medicine

Role Summary The Health Plan Claims Analyst I is responsible for administrative, operational and programmatic support services within an assigned area/department. This role requires strong problem‑solving, analytical and organizational skills, and involves making recommendations to program leadership for quality improvement. The analyst coordinates workflow across payors, providers and program leadership, requiring effective communication. Responsibilities Guide network providers on the enrollment process and educate on health plan rules and claims processing. Maintain provider network agreements (PNA) and communicate status to patient care and claims teams. Educate providers on health program rules, authorization processes, documentation requirements, and clinical center review process. Coordinate requested medical documentation from program sponsor, ensure it meets documentation requirements, and liaise with providers and medical review team. Review claims information for quality assurance, recommend process improvements or changes in documentation or workflow. Troubleshoot incorrectly billed services and support patients and team members on billing issues. Respond to provider inquiries regarding coverage and liaise with sponsor/payor to resolve inquiries. Troubleshoot medical claims payment issues. Approve claims for patients and document claim decisions in e-Claims portal. Work directly with patient care team to facilitate service authorization. Maintain knowledge of health program coverage and payment guidelines, monitor changes, and notify leadership. Communicate resolution status to care teams and providers. Identify and communicate billing patterns to leadership. Liaise with staff in other departments to coordinate program activities and training, ensuring cooperative efforts and resource utilization. Recommend new ideas and concepts for program themes, materials and resources to supplement or replace existing components. Perform other duties as assigned. Qualifications Bachelor’s degree preferred or Associate’s degree with at least 2 years of relevant experience. Minimum 2 years experience in medical billing or health claims; experience with IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding. Compensation Salary range: $64,526.72 – $81,675 annually. 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. #J-18808-Ljbffr Mount Sinai Health System