Billing Manager

Physician Billing Auditing Manager

Hybrid work setting, Florida residency required

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 Way

Our 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.

Position Summary:

The PB Audit Manager is responsible for leading and managing the auditing functions of Physician Practices across multiple specialties with a focus on Physician & Coder Education. This role ensures coding accuracy, compliance with regulatory guidelines, and optimal reimbursement through proactive audit strategies, education and collaboration with clinical, coding and financial teams

Key Responsibilities:

• Audit Oversight & Execution
  • Develop and implement a comprehensive auditing program for professional fee coding.
  • Conduct routine and targeted audits to assess coding accuracy, documentation quality, and compliance with CMS, CPT, ICD-10, and payer-specific guidelines.
  • Analyze audit findings and identify trends, risks, and opportunities for improvement in documentation and coding accuracy.
• Team Leadership & Development
  • Provide mentorship, performance feedback, and ongoing training.
  • Identify organizational opportunities to partner with Providers, improve coding quality and prevent unnecessary corrective actions
  • Plan Provider education with Physician Practices as warranted
• Compliance & Risk Management
  • Collaborate with Compliance and Legal departments to ensure adherence to federal and state regulations.
  • Support internal and external audit processes, including RAC, MAC, and payer audits.
  • Maintain documentation of audit results and corrective actions for compliance reporting.
• Reporting & Analytics
  • Prepare detailed audit reports and dashboards for leadership, highlighting key metrics and trends.
  • Roll-out targeted education for improvement based on findings
• Stakeholder Collaboration
  • Work closely with physicians, Physician Practice Administration, Clinical Information Systems, and revenue cycle leadership to resolve coding discrepancies and improve documentation practices.
  • Serve as a subject matter expert on coding guidelines and reimbursement policies.

Qualifications:

• Education & Certification
  • Bachelor's Degree in Health Information Management, Healthcare Administration, or related field (preferred).
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential required.
  • Certified Professional Medical Auditor (CPMA) preferred.
• Experience
  • Minimum 5 years of experience in coding, with at least 2 years in a leadership or auditing role.
  • Experience providing coder mentorship and physician education in PB coding matters.
  • Strong knowledge of CPT, ICD-10, HCPCS, and E/M coding guidelines.
  • Experience with electronic health records, coding software, and audit tools.
• Skills
  • Excellent analytical, organizational, and communication skills.
  • Proficiency in Microsoft Office Suite and data reporting tools.

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. Our robust employee benefits package includes:

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!