Revenue Cycle Specialist III (Professional Billing)

Cedars-Sinai Medical Center•Torrance, CA

22h•Remote

About The Position

This Revenue Cycle Specialist III works under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Professional Fee billing and collections. Duties include but are not limited to, reviewing and submitting claims to payors, performing account follow-up activities, updating information on patient accounts, reviewing and processing credits, posting payments, and account reconciliations. Positions at this level require expert knowledge, skill and proficiency in CS-Link functions and multi-specialty areas of the revenue cycle. Incumbents have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same. Incumbents are expected to research, analyze and resolve complex cases and problem accounts with minimal assistance. Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor. This position may be cross-trained in other revenue cycle functions and provide back-up coverage: Develops and maintains excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients, performing duties that include identifying, analyzing, resolving, and responding to our client’s inquiries, concerns, and issues, and following up on accounts to ensure resolution. Responds to patient, insurance company, and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution. Makes recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner. Keeps informed if rules and regulations affecting coding and reimbursement by maintaining current CPT and ICD-10 knowledge of assigned areas for accurate assessment of charge review. Creates manual invoices and follows up for payment. Directs billing to the correct entity i.e. (Vision Plan, Personal Family, or Non-Covered). Distributes payments to avoid inaccurate billing to patients. Identifies possible coding deficiencies through charge/medical record review and coordinates coding review to ensure accurate charge capture, enhancing third-party reimbursement and minimizing audit liability. Attends huddles as requested and participates in group problem-solving. Calls out fee schedule discrepancies and system errors. Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas

Requirements

High School Diploma or GED required
Minimum of 4 years of professional and/or hospital revenue cycle billing experience required
Physician billing experience
Basic computer and navigation skills
Ability to perform relevant business math (including addition, subtraction, multiplication and division)
Good verbal and written communication skills
Keyboard and data entry proficiency
Ability to handle multiple tasks in a fast paced and high-volume environment with conflicting demands on time and attention
Ability to prioritize and organize work to complete assignments in a timely, accurate manner
Professional and courteous demeanor

Nice To Haves

College level courses in Finance, Business or Health Insurance are preferred
Professional billing experience highly preferred
Experience following up on claims or appealing denied claims preferred
Experience with MS office, Epic, and CS-Link preferred
Working knowledge and understanding of regulatory and CSHS policies and procedures preferred
Basic understanding of HIPAA and other privacy information guidelines preferred

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
Serving as a technical resource (subject matter expert) to others
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
Returning calls and performing research needed to bring account to final resolution
Making recommendations for improved operational processes
Keeping informed of rules and regulations affecting coding and reimbursement
Maintaining current CPT and ICD-10 knowledge of assigned areas
Creating manual invoices and following up for payment
Directing billing to the correct entity
Distributing payments to avoid inaccurate billing to patients
Identifying possible coding deficiencies through charge/medical record review
Coordinating coding review to ensure accurate charge capture
Attending huddles as requested
Participating in group problem-solving
Calling out fee schedule discrepancies and system errors