Revenue Cycle Specialist I - Commercial Collections

About the Role

Under general supervision and following established practices, policies, and guidelines, provides billing support to Patient Financial Services. Performs duties including reviewing and submitting claims to third-party payors, performing account follow-up activities, updating account information, and more. This position requires a basic knowledge of the assigned area and a general understanding of department functions and the revenue cycle. Incumbents are expected to organize, prioritize, and perform work in a timely manner within established guidelines, practices, and procedures. This position may be cross-trained in other office functions and provide back-up coverage.

Responsibilities

• Develops and maintains excellent working relationships with Cedars-Sinai Medical Network, Primary Care Clinical Departments, external clients, and patients.
• Identifies, analyzes, resolves, and responds to client inquiries, concerns, and issues, and follows up on accounts to ensure resolution.
• Serves as liaison between CSRC Services and Clinical Departments in the coordination of department-specific responsibilities.
• Performs billing duties through charge capture to maximize reimbursement.
• Responds to patients and guides them through external billing processes (e.g., CSI, Quest, or other outside entities).
• Handles inquiries from insurance companies and other authorized third parties, including returning calls and conducting research to resolve accounts.
• Maintains current knowledge of CPT and ICD-10 coding rules and regulations for accurate charge review.
• Reviews accounts on OCS reports with providers to identify balances approved or declined for further collection activity.
• Initiates calls to patients to collect on unresolved balances if approved; routes declined accounts to the appropriate work queue for final resolution.
• Escalates fee schedule discrepancies and system errors.
• Participates in department meetings and provides feedback to management on process improvements.
• Adheres to verbal and written instructions to achieve desired results and maintains department documentation standards.
• Correctly enters data in fields and maintains acceptable levels of speed and accuracy.
• Monitors assigned work queues and workload, ensuring timely and accurate resolution of accounts.
• Processes incoming correspondence based on reason code in a timely and accurate manner.
• Ensures account information is complete and accurate and adheres to payment timeline protocols.
• Assists team members with account resolution as needed.
• Demonstrates detailed knowledge of Cedars-Sinai core patient accounting systems and/or department-specific systems and uses them effectively.

Requirements

• High school graduate or GED required.
• College-level courses in finance, business, or health insurance preferred.
• A minimum of 1 year of hospital or professional billing and/or collections experience required.
• Commercial collections experience a plus.

Benefits

• Healthcare and dental insurance.
• Paid vacation and time off.
• 403(b) retirement plan.

Cedars-Sinai is committed to creating a dynamic, inclusive environment that fuels innovation, with a culturally and ethnically diverse staff reflecting the community it serves.