Revenue Cycle Specialist III (Orthopedics)

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What you will 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 but are 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 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:

• Develops and maintains 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. Serves as liaison between CSRC Services and Clinical Departments in the coordination of billing and reimbursement. Responds to patient, insurance company, and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution.
• Makes recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.
• Keeps informed if 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. Discusses cash pricing for cosmetic services and cash packages with patients and manages credits for package and/or cosmetic services.
• Identifies and advances new services for appropriate pseudo-code creation. Identifies possible coding deficiencies through charge/medical record review and coordinates coding review to ensure accurate charge capture, enhancing third-party reimbursement and minimizing audit liability.
• Reviews 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.
• Attends specialty clinical huddles as requested and participates in group problem-solving.
• Escalation of fee schedule discrepancies and system errors.

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

Originally posted on Himalayas