Revenue Cycle Specialist III (Professional Billing)

Cedars-Sinai•Torrance, CA

3h•Remote

About The Position

Cedars-Sinai, an organization recognized for its high-quality medical care and employee engagement, is seeking a Revenue Cycle Specialist III with expertise in Professional Fee billing and collections. This role supports the revenue cycle management by reviewing and submitting claims, performing account follow-up, updating patient account information, processing credits, posting payments, and reconciling accounts. The position requires expert knowledge of CS-Link functions, multi-specialty revenue cycle areas, regulatory requirements, payor contracts, and CSHS policies. Incumbents are expected to research, analyze, and resolve complex cases with minimal assistance, and may serve as a technical resource or act in the absence of a lead or supervisor. This role may also involve cross-training in other revenue cycle functions and providing back-up coverage.

Requirements

Expert knowledge, skill, and proficiency in CS-Link functions.
Expert knowledge in multi-specialty areas of the revenue cycle.
Expert knowledge and understanding of regulatory requirements, payor contracts, and CSHS policies governing billing and collections.
Sound interpretation of regulatory requirements, payor contracts, and CSHS policies.
Ability to research, analyze, and resolve complex cases and problem accounts with minimal assistance.
Ability to serve as a technical resource (subject matter expert) to others.
Ability to act in the absence of the lead and/or supervisor.
Ability to develop and maintain excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients.
Ability to identify, analyze, resolve, and respond to client inquiries, concerns, and issues.
Ability to follow up on accounts to ensure resolution.
Ability to respond to patient, insurance company, and other authorized third-party inquiries.
Ability to return calls and perform research needed to bring accounts to final resolution.
Ability to make recommendations for improved operational processes.
Ability to keep informed of rules and regulations affecting coding and reimbursement.
Maintained current CPT and ICD-10 knowledge of assigned areas for accurate assessment of charge review.
Ability to create manual invoices and follow up for payment.
Ability to direct billing to the correct entity.
Ability to distribute payments to avoid inaccurate billing to patients.
Ability to identify possible coding deficiencies through charge/medical record review.
Ability to coordinate coding review to ensure accurate charge capture.
Ability to attend huddles as requested and participate in group problem-solving.
Ability to call out fee schedule discrepancies and system errors.

Nice To Haves

Cross-trained in other revenue cycle functions.
Provide back-up coverage for other revenue cycle functions.

Responsibilities

Reviewing and submitting claims to payors.
Performing account follow-up activities.
Updating information on patient accounts.
Reviewing and processing credits.
Posting payments.
Account reconciliations.
Researching, analyzing, and resolving complex cases and problem accounts with minimal assistance.
Serving as a technical resource (subject matter expert) to others and potentially acting in the absence of the lead and/or supervisor.
Developing and maintaining excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients.
Identifying, analyzing, resolving, and responding to client inquiries, concerns, and issues.
Following up on accounts to ensure resolution.
Responding to patient, insurance company, and other authorized third-party inquiries, including returning calls and performing necessary research to bring accounts to final resolution.
Making recommendations for improved operational processes to ensure timely and accurate receipt of billing information from client groups.
Keeping informed of rules and regulations affecting coding and reimbursement by maintaining current CPT and ICD-10 knowledge of assigned areas for accurate assessment of charge review.
Creating manual invoices and following up for payment.
Directing billing to the correct entity (e.g., Vision Plan, Personal Family, or Non-Covered).
Distributing payments to avoid inaccurate billing to patients.
Identifying possible coding deficiencies through charge/medical record review and coordinating coding review to ensure accurate charge capture, enhancing third-party reimbursement and minimizing audit liability.
Attending huddles as requested and participating in group problem-solving.
Calling out fee schedule discrepancies and system errors.