[Hiring] Specialty Collector @Mount Sinai Medical Center

Role Description

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 Responsibilities

• Researches 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.

Qualifications

• High School Graduate or equivalent level of training.
• Minimum 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.

Requirements

• Knowledge 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

• 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!