Revenue Cycle Specialist III (Orthopedics)

What you will be doing in this role

• Work under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Hospital, Professional Fee billing and collections
• Review and submit claims to payors
• Perform account follow-up activities
• Update information on patient account
• Review and process credits
• Post payments and perform account reconciliations
• Require expert knowledge, skill and proficiency in CS-Link functions and multi-specialty areas of the revenue cycle
• Have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same
• Research, analyze and resolve complex cases and problem accounts with minimal assistance
• Serve as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor
• May be cross-trained in other revenue cycle functions and provide back-up coverage
• Develop and maintain excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients, performing duties that include identifying, analyzing, resolving, and responding to our client's inquiries, concerns, and issues, and following up on accounts to ensure resolution
• Serve as liaison between CSRC Services and Clinical Departments in the coordination of billing and reimbursement
• Respond to patient, insurance company, and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution
• Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner
• Keep informed 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
• Input specialty or cosmetic charges, create manual invoices and follow up for payment
• Direct billing to the correct entity i.e. (Vision Plan, Personal Family, or Non-Covered)
• Distribute payments to avoid inaccurate billing to patients
• Discuss cash pricing for cosmetic services and cash packages with patients and manage credits for package and/or cosmetic services
• Identify and advance new services for appropriate pseudo-code creation
• Identify possible coding deficiencies through charge/medical record review and coordinate coding review to ensure accurate charge capture, enhancing 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 collection 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
• Attend specialty clinical huddles as requested and participate in group problem-solving
• Escalate fee schedule discrepancies and system errors

Qualifications

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

Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas