Revenue Cycle Specialist III (International) - Onsite

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 you will be doing in this onsite role:

Under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting international hospital, professional billing and collections. Duties include but not limited to, 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 require expert knowledge, skill and proficiency in Epic 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 Epic 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:

Develops and maintains excellent working relationships with Cedars-Sinai Medical Network, Surgical Clinical Departments, external clients, and patients. Performs duties that include identifying, analyzing, resolving, and responding to our client?s 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 guides them through external billing processes, such as CSI, Quest, or other outside entities. Also responds to insurance company, 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.

Inputs specialty or cosmetic charges, 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 and escalates new services for appropriate pricing and pseudo-code creation. 

Identifies coding deficiencies through charge/medical record review and coordinates coding review to ensure accurate charge capture, maximizing third-party reimbursement and minimizing audit liability. 

Escalation of fee schedule discrepancies and system errors. 

Team knowledge sharing of contracting changes. 

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.
• International billing experience a plus. 

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.