EOB Reviewer at Mount Sinai Medical Center

EOB (Explanation of Benefits) Reviewer  -Healthcare Insurance Reimbursement Specialist

Hybrid work form home schedule after training

Base salary plus bonus!

As Mount Sinai grows, so does our legacy of caring.

Located in the heart of Miami Beach, overlooking the breathtaking intracoastal waterway, Mount Sinai Medical Center is dedicated to providing exceptional health care to our diverse community enhanced through innovation, technology, teaching, and research.

Mount Sinai is South Florida's largest private independent not-for-profit hospital with 672 beds, and a tight-knit community of more than 4,000 employees.

We provide world-class care:

• Named one of America's 250 Best Hospitals for 2023, 2022, 2021 and 2020 by Healthgrades, positioning Mount Sinai among the top 5% of hospitals in the nation for overall clinical excellence
• A pioneer in innovative medical research in areas such as cardiology, cancer, memory disorders and pulmonary diseases
• The most cardiac surgery procedures performed in South Florida over the past 10 years
• A new seven-story Surgical Tower with 154 all-private rooms and patient centered technology promotes an exceptional patient experience

Position Responsibilities:

1.   Perform accurate and timely review of EPIC Hospital Billing Explanation of Benefits Review work queues and Hospital Billing work queue to ensure that Managed Care payment variances 

 2.   Compare payment received to expected payment calculated in FinThrive system. Ensure proper reimbursement is received from contracted carriers on patient's account.          

 3.   Notify manager of any pattern of similarities on denials and/or incorrect payments.         

4.   Refer accounts to appropriate areas if additional follow-up is required.             

5.   Post appropriate adjustments to patient's accounts when necessary.

6.   Notify manager of any FinThrive system issues or incorrect calculations that require further review/correction. 

7.   Follow up on issues addressed to ensure resolution.              

8.   Perform reproration of balances within the patient's account buckets as necessary.         

9.  Notify cashier's office of any discrepancies between payment posted and electronic remittance payment reflected in FinThrive.    

10. Document expected payment information indicating underpaid/overpaid amount and/or denial reason which requires further follow up. 

11.  Review of daily report Primary Paper Claims printed out of EPIC  and weekly report Claims missing Adjustments to ensure accounts are adjusted accordingly.      

12.  Provide assistance to Business Office in the understanding of contracts and address questions and problem solving .      

Requirements: 

• High School graduate required, Associates desired
• One-year prior hospital/business office experience preferred: reimbursement / payment experience, collections, EOB review/ analysis
• Specific experience with reviewing Explanation of Benefits documents or similar financial and healthcare-related records desired.
• Experience with Epic or FinThrive Revenue Management desired        

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
• Tuition reimbursement
• Employee assistance program
• Wellness program

Eob Reviewer