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Revenue Cycle Specialist II

2 months ago

Modesto, United States Cedars-Sinai Full time
Job Description

Align yourself with an organization that has a reputation for excellence Cedars Sinai was awarded the National Research Corporations Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. Join us Discover why U.S. News & World Report has named us one of Americas Best Hospitals.

What will you be doing in this role?

Under general supervision and following established practices, policies, and guidelines, provides commercial collections support to Patient Financial Services, performing duties which may include reviewing and resubmitting claims to third party payors, performing account follow-up activities, updating information on account, etc. Positions at this level require advanced knowledge in specialized functions and a full understanding of the revenue cycle. Incumbents work independently and have strong customer service, analytic and prioritization skills, and are able to understand, interpret and explain payor contracts and CSMC billing and collections policy and practices. Incumbents may assist other team members.

This position may be cross trained in other revenue cycle functions and provide back-up coverage. The Revenue Cycle Specialist II:

  • Participates in department meetings and provides feedback to management on how to improve department processes. Adheres to instructions, verbal and written, to achieve desired results.
  • Adheres to documentation standards of the department and properly uses activity codes. Correctly enters data in fields. Maintains acceptable levels of speed and accuracy.
  • Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner. Takes initiative on issues and/or problems by advancing them to supervisor.
  • Exemplifies high standards of professionalism, responsibility, accountability and ethical behavior.
  • Processes incoming correspondence, based on reason code, timely and accurately.
  • Ensures information on the account is complete and accurate. Adheres to payment timeline protocol.
  • Adheres to payment timeline protocol and assists other team members with resolution of accounts when needed.
  • Demonstrates detailed knowledge of Cedars-Sinai core patient accounting systems and/or department specific systems and uses them effectively and efficiently.

Additional primary duties and responsibilities that are only performed in this specific department:

  • In the capacity of revenue guardian, develops and maintains excellent working relationships with Cedars-Sinai Medical Network, Primary Care Clinical Departments, external clients, and patients. Performs duties that include identifying, analyzing, resolving, and responding to our clients inquiries, concerns, issues, and following up on accounts to ensure resolution. Serves as liaison between CSRC Services and Clinical Departments in the coordination of billing through charge capture to maximize reimbursement. Responds to patients and guide them through external billing processes, such as CSI, Quest, or other outside entities. Also responds to insurance companies, and other authorized third-party inquiries, including the return of calls and research needed to bring accounts to final resolution.
  • Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.
  • Keeps apprised 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.
  • Creates manual invoices for team sports billing. 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, maximizing third-party reimbursement and minimizing audit liability.
  • Review accounts on OCS report with providers to identify balances approved or declined for further collection activity. If approved, initiate calls to patients to collect on unresolved balances. If declined, set notification in OCS report format to ensure the account is routed to the appropriate work queue for final resolution.

Qualifications Requirements:
  • High school diploma or GED required.
  • A minimum of three years of experience in professional billing and/or collections experience required. Four years experience or more preferred. Internal Medicine experience preferred.

Why work here?
Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b), we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.

Req ID : 3819
Working Title : Revenue Cycle Specialist II
Department : CSRC PB - Group
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Financial Services
Job Specialty : Patient Billing
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $22.07 - $33.11