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Job Description

Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW

To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it reaches the responsible individuals. Must also maintain accurate record keeping via either electronic documentation within the hospital Eagle and Canopy systems or written record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of both internal and external correspondence.

Is cognizant of the philosophy, standards, objectives and policies of the Department and the Hospital Center.

Qualifications

+ Applicable work experience may be considered in lieu of educational requirements. Associate Degree

+ Strong clerical skills required

+ Very Strong Computer skills on Excel and Word

+ Strong Communication skills

Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West

Responsibilities

A. Clinical/Technical/Service

+ Demonstrates the ability to perform clinical/technical/service/administrative tasks:

+ Prioritizes Insurance Requests / Denials when received in the department as per protocol

+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews

+ Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in Allscripts

+ Meets time frame for reviews / appeals as specified by Insurance / State & Federal regulation.

+ Enters concurrent review information for Review Nurses in Allscripts

+ Obtains/Prepares Medical Records and other documentation for Photo Copying Service, outside 2nd party and / Discharge Appeals

+ Maintain the integrity of the Medical Record.

+ Utilizes Hospital Mainframe programs and Allscripts Systems effectively

+ Process Mail - Sort, identifies location and distribute to appropriate departments

+ Monitors Concurrent Nurse denial phone calls for UM Nurse to follow

+ Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests)

+ Support Appeals Nurse / Manager by confirming status of denials

+ Tracking status of Medical Record requests for denials to insure that they are received timely

+ Completes assignments based on priorities

B. Organizational/Managerial

+ Participates in the departments performance improvement activities.

+ Maintains patient/employee confidentiality in the management of information.

+ Adheres to the organizations policies regarding time and attendance.

+ Demonstrates reliability and trustworthiness.

+ Manages time and other resources to meet established goals within the agreed upon time frames.

+ Demonstrates flexibility in the acceptance and completion of work assignments.

+ Complies with accepted dress code and maintains a professional image.

C. Educational/Professional Development

+ Participates in the development of other staff members.

+ Meets regulatory, licensure and annual health assessment requirements.

+ Identifies learning strengths and needs

+ Utilizes learning resources.

D. Communication/Relationships

+ Displays courtesy, tact and patience during interactions with all members of the hospital staff and extended community.

+ Notifies Supervisor of obstacles / problems affecting the completion of assignments

+ Communicates issues impacting the department's operations to the Supervisor

+ May be required to perform other duties as assigned or perform other duties when necessary.

About Us

Strength through Unity and Inclusion

The 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 System:

Mount 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 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. 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.

Compensation Statement

Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $20.4566 - $28.5293 Hourly. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.