Revenue Cycle Specialist III (Remote)

Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation?s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We provide an amazing benefits package that includes health care, dental, vision, paid time off and a 403(b). Discover why U.S. News & World Report has named us one of America?s Best Hospitals!

What will I be doing in this role?

The Revenue Cycle Specialist III works under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Hospital, Professional Fee billing and collections. Duties include reviewing and submitting claims to payors, performing account follow-up activities, updating information on patient account, reviewing and processing credits, posting payments, and account reconciliations. Positions at this level requires 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. Primary duties include:

• Independently responds timely and accurately to all requests. Interacts professionally and courteously with employees and internal and external customers.
• Adheres to instructions, verbal and written, to achieve desired results. Assists supervisors in composing policy and procedure manuals and statements for the department. Communication is clear and easy to understand. Thoughts are coherent and logically presented.
• Effectively manages time, maintains a clean and orderly workstation. Prioritizes work activities consistent with department goals and can balance daily workload and several projects.
• Exemplifies high standards of professionalism, responsibility, accountability and ethical behavior. 
• Applies detailed knowledge of and aligns with all hospital, physician, and department policies, procedures (e.g., PHI)
• Demonstrates detailed knowledge of CS- Link and/or department specific systems and uses them effectively.
• Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner. 
• Adheres to documentation standards of the department and properly uses activity codes. 
• Accurately bills multispecialty claims within established timelines and initiates dialog with payors, patients and departments. 
• May assume lead role in the absence of the supervisor, oversee day to day department activities and is able to effectively address any concerns that may arise. 

Department specific responsibilities include:

Analyzes, trends, reports out, and resolves pended claims in PB Claim Edit WQs and PB Payer Rejection Insurance Follow-up WQs to ensure clean claim submissions and timely reimbursement.

Completes special PB claims related projects as assigned. These projects could include trending issues to ensure workflow efficiencies and end user training opportunities, charge correct rebill projects, review and analysis of Retro WQ opportunities, rebill efforts for missing ICN, net down and write-off AR resolution needs (i.e. Provider not credentialed), and contacting payers as needed to ensure we have current claims logic and workflow understanding gaps covered to help support successful clean claim submissions. 

Monitor and report PB clean claim submission opportunities that involve integration from CSLink Resolute to external vendors such as our clearinghouse and payers. 

Familiarity with the ANSI X12 837 format used for electronic submission of professional healthcare claims. Understanding of the key segments, including:

• ISA/GS/GE/ST Segments: Interchange control headers and functional group details.
• NM1 Segments: Identification of patients, providers, and payers.
• CLM Segment: Claim information, including billing details, service lines, and claim totals.

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Requirements:

• High School Diploma or GED required. College level courses in finance, business or health insurance preferred.
• Minimum of 4 years of hospital or professional billing and/or collections experience required. Professional billing experience in claims highly preferred.

Why work here?

Beyond outstanding employee benefits (including health, vision, dental and life and insurance) we take pride in hiring the best employees. Our accomplished and compassionate 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.