Senior CBO Appeals Analyst
: Job Details :


Senior CBO Appeals Analyst

Mount Sinai Health System

Job Location : New York,NY, USA

Posted on : 2025-08-06T01:03:54Z

Job Description :
Description

The 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.
    • Qualifications

    Bachelor's degree or greater in related field or equivalent education/experience

    Five years minimum of managed care experience in insurance claims or contracts

    Four to Five years of financial analysis experience in a hospital/healthcare environment is required.

    Advanced knowledge of Epic, Contract Manager, and Microsoft Excel

    Working knowledge of other Microsoft applications including Word, and Outlook

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