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Coding Specialist CCS
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Personal Information

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Are you legally authorized to work in the U.S.? (If hired, verification will be required consistent with federal law).

Have you ever been convicted of any crime, pleaded guilty or nolo contendere, had an adjudication withheld for any crime, and/or been released from confinement following a conviction for any criminal offense?
If yes, please give date, place, and nature of such conviction. This will not necessarily disqualify you for employment.

Are you presently charged with any violation of the law?
If yes, give date, place and nature of each such charge:

Are you currently excluded from participating in any federally funded healthcare program - including Medicare and Medicaid - or are you aware of any potential exclusion from a federally funded health program?

Have you ever been a defendant in a civil action for an intentional tort, such as harassment, fraud, defamation, assault and battery, invasion of privacy or false imprisonment?
If yes, include the nature of the intentional tort and the disposition of the action.

Have you ever worked at Mount Sinai Medical Center before?

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Agreement

By submitting my application I agree to the following:

I certify that all statements made by me on this application are true and complete to the best of my knowledge and without consequential omissions of any kind. I also certify that that I have not knowingly  withheld any information that would affect this application unfavorably. I understand and agree that any false statement or omission as discussed above with respect to the information required on the application is ground for refusal to hire me or for withdrawal of any offer of employment made to me or for the termination of my employment with Mount Sinai Medical Center.

I authorize Mount Sinai Medical Center to investigate all matters covered by this application as well as statements made by me on this application. I also authorize my previous employers, schools, persons named as references or former supervisors to disclose information they may have regarding my suitability for employment and the matters addressed in my application and release them from any liability arising out of their disclosure of such information. I further release Mount Sinai Medical Center and its employees and agents from all liability for damages whatsoever if an employment offer is not tendered to me or is withdrawn or if my employment is terminated because of the results of the investigation of the application.

I understand that if I am offered employment by Mount Sinai Medical Center such employment will be fore no definite term and will be terminable at the will of myself of Mount Sinai Medical Center at any time. I understand that no representatives of Mount Sinai Medical Center other than the Chief Executive Officer has the authority to enter into any employment relationship with anyone for a definite term or make any agreement contrary to the foregoing and that any such agreement must be in writing and signed by the Chief Executive Officer.

I understand, where permissible under applicable state and local law, I may be subject to a pre-employment drug and nicotine test after receiving a conditional offer of employment, and must receive a negative result before being permitted to commence work with MSMC. I also may be subject to post-employment drug tests: (1) post-accident; (2) random; or (3) upon reasonable suspicion in accordance with applicable federal, state and local law. I understand, where permissible under applicable federal, state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with the company.

I understand that if I am employed, I may be subject to temporary or permanent schedule changes and that due to the nature of the operation of a hospital, it may be necessary to work shifts other than originally or normally assigned.

I understand that Mount Sinai Medical Center may require an employee to cooperate in the investigation of an incident or situation as judged necessary by the Director of Security and/or the Director of Human Resources or their designees.

If hired, as an employee of Mount Sinai Medical Center, I will abide by the Operation Excellence Standards of Performance and pledge to live and uphold these standards of performance from the date of hire forward.

I understand that I may be dismissed if I, at any time, reveal confidential information concerning the organization, patients or fellow employees.

I hereby acknowledge that I have read and understand the above statements.

Candidate Sign Off

I certify that all of the information in this application is true and correct as of this date.

Application Review