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DescriptionThe Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including institutional, as well as professional payment systems. This position is an internal subject matter expert supporting staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.
DescriptionThe Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including institutional, as well as professional payment systems. This position is an internal subject matter expert supporting staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.In collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals of enhancing contract compliance by researching, analyzing, documenting, and reporting underpayment trends, payer updates, payer regulations, and provide feedback on workflow procedures pertaining to our negotiated contracts.Responsibilities
- Provides validation reviews, audits, documentation and training for the area of knowledge, sharing information with CBO management and other revenue producing areas or departments.
- Provides training and education to CBO Appeals Analysts, as well as guided workflows to assist in contract compliance analysis.
- Develops and maintains standard contract compliance analyses of MSHP IPA negotiated contracts utilizing contract manager and other data sources.
- Monitor State and Federal policies, regulations and legislation affecting contract reimbursement.
- Attends monthly payer, client and accounts receivable meetings.
- Routinely meets with underpayment team manager and director to provide updates on KPI's.
- Research and analyze impacts of various State and Federal Medicare and Medicaid policies, regulations, legislation and other proposals, including managed care payer reimbursement policy changes.
- Analyze impacts of various rate increase proposals.
- Assist in special projects as needed.
- Other relevant duties as assigned.
QualificationsBachelor's degree or greater in related field or equivalent education/experienceFive years minimum of managed care experience in insurance claims or contractsFour to Five years of financial analysis experience in a hospital/healthcare environment is required.Advanced knowledge of Epic, Contract Manager, and Microsoft ExcelWorking knowledge of other Microsoft applications including Word, and OutlookEmployer DescriptionStrength through Unity and InclusionThe 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 SystemMount 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, receiving high Honor Roll status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's “Best Children's Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's “The World's Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.Equal Opportunity EmployerThe 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. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.CompensationThe Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $64526.72 - $81675 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.Seniority level
- Seniority levelNot Applicable
Employment type
Job function
- Job functionBusiness Development and Sales
- IndustriesHospitals and Health Care
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