Revenue Cycle Specialist III (Orthopedics)

This is a revenue cycle role at Cedars-Sinai Medical Center, working under general supervision on hospital and professional fee billing and collections. It is for someone with expert-level knowledge of CS-Link functions and multiple revenue cycle areas, who can resolve complex accounts with little help and serve as a technical resource to others. The position may be cross-trained in other revenue cycle functions and provide back-up coverage.

What you will do

• Review and submit claims to payors, perform account follow-up, update patient account information, review and process credits, post payments, and reconcile accounts.
• Build and maintain working relationships with Cedars-Sinai clinical departments, external clients, and patients. Identify, analyze, resolve, and respond to client inquiries and concerns, and follow up on accounts until they are resolved.
• Act as liaison between CSRC Services and clinical departments to coordinate billing and reimbursement.
• Respond to patient, insurance company, and other authorized third-party inquiries, including returning calls and doing the research needed to bring an account to final resolution.
• Recommend improvements to operational processes so billing information comes in from client groups accurately and on time.
• Keep current CPT and ICD-10 knowledge for assigned areas so charge review assessments are accurate.
• Input specialty or cosmetic charges, create manual invoices, and follow up for payment. Direct billing to the correct entity, such as Vision Plan, Personal Family, or Non-Covered. Distribute payments to avoid billing patients incorrectly. Discuss cash pricing for cosmetic services and cash packages with patients, and manage credits for package and cosmetic services.
• Identify and advance new services for appropriate pseudo-code creation. Spot possible coding deficiencies through charge and medical record review, and coordinate coding review to ensure accurate charge capture, improve third-party reimbursement, and limit audit liability.
• Review accounts on the OCS report with providers to identify balances approved or declined for further collection activity. If approved, make collection calls to patients on unresolved balances. If declined, set a notification in OCS report format so the account routes to the correct work queue for final resolution.
• Attend specialty clinical huddles as requested and take part in group problem-solving.
• Escalate fee schedule discrepancies and system errors.

What they are looking for

The posting states this level requires expert knowledge, skill, and proficiency in CS-Link functions and multi-specialty areas of the revenue cycle. Incumbents need expert knowledge and understanding of regulatory requirements, payor contracts, and CSHS policies governing billing and collections, plus sound interpretation of them. They are expected to research, analyze, and resolve complex cases and problem accounts with minimal assistance. The role also serves as a subject matter expert to others and may act in the absence of the lead or supervisor.

Location

Approved remote states: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas.

About Cedars-Sinai

Cedars-Sinai was ranked as the No. 1 Workplace by Indeed.com and received the Advisory Board Company's Workplace of the Year award, which recognizes hospitals and health systems nationwide with outstanding employee engagement. The benefit package includes paid time off, health care, and a 403(B), along with competitive compensation. U.S. News & World Report has named Cedars-Sinai one of America's Best Hospitals.