1,836 Revenue Cycle Specialist jobs in the United States

Job Description

Job Description

Position Summary: The

Revenue Cycle Specialist is responsible for the accurate and timely submission of medical claims to insurance companies and other payors. The medical biller posts payments or adjudications as appropriate. Using knowledge of billing practices and standards including third party payor requirements, the medical biller will investigate denials to process appeals and collect payment. In addition, this position is responsible for reviewing coding for outpatient services for reimbursement and research compliance.

Supervision: Director of Health Information Management

Medical Billing:

• Performs claim review, verifies accuracy and completeness of all required information to perform submission to Medicare, Medicaid, commercial and private insurance payers
• Applies payments and adjustments to patient accounts.
• Review explanations of benefits for correct adjudication and payment according to applicable managed care contract terms and reimbursement.
• Review of unpaid claims, researching denials and/or lack of activity to ensure timely payment and maintain cash flow.
• Follow up with insurance payers for processing appeals and errors.
• Receive and resolve inquiries, concerns, or complaints related to patient accounts from patients, insurance carriers, employers, etc.
• Provide customer service and interact with clinicians, managers, and clients as needed to resolve outstanding items.
• Responsible for resolution and appropriate refunding of credit balances, denied claims, and charges on hold. Includes working credit balance reports as needed.
• Meet productivity and quality assurance benchmarks.

Coding:

• Identifies and assigns appropriate codes for the purpose of reimbursement, research, and compliance in accordance with ICD-10 and CPT coding guidelines.
• Accurately extracts clinical information from records according to established requirements using abstracting software.
• Interpret coding rules and general policies in addition to determining appropriate conclusions
• Complies with all federal, local and other legal requirements as they relate to medical coding practices.
• Observes confidentiality and safeguards all patient related information Communicates in a positive and professional manner with visitors, physicians, and staff.
• Must be able to explain codes, terminology and coding guidelines to physicians and hospital personnel.
• Maintains an optimal working relationship with peers, other departments, and physicians
• Attends continuing education classes to maintain coding proficiency in ICD-10-CM, CPT/HCPCS, and other areas as deemed necessary by management.
• Perform other job-related duties as required.

Job Skills:

• Excellent command of diagnostic and procedural classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement.
• Current understanding of applicable coding guidelines, state and federal regulations, and managed care guidelines.
• Communicates effectively both verbally and in writing to convey and receive information.
• Knowledge of medical terminology and disease process
• Proficient knowledge of ICD, CPT/HCPCS coding systems
• Proficient in encoder technology and knowledge of third-party payer requirements
• Demonstrated skills working with Microsoft Excel and Office Suite products and EMR data eClinical EMR experience a plus)
• Possess strong written and verbal communications skills to communicate effectively with individuals at all levels of the organization
• Ability to adjust to changes in workflow
• Thoroughness and attention to detail
• Ability to work independently

Training and Education

Associate degree and/or Diploma in medical coding and billing or credentialed in medical coding and billing required.

Work Experience

• 5 or more years of experience in medical coding and billing
• CCA, CCS, CCS-P
• RHIT preferred
• Diploma in medical coding and billing or Credential in medical coding and billing required
• Customer Service Experience preferred

Employee Charge to NOVUS Mission:

Candidates should be aware of NOVUS Health strong commitment to diversity and inclusion. With a focus on providing trauma informed, holistic health we expect all staff to meet patients, community partners, and co-workers with respect and dignity. We challenge each other to acknowledge biases that exist in healthcare, including racial, gender, gender identity, sexual orientation, ethnicity, and/or personnel beliefs. We look for ways to eliminate these biases at all points of services and care. Together as a team member of NOVUS, we will begin to break down barriers, build access, and create healthier communities.

Overview

Revenue Cycle Specialist

Cameo Dental Specialists

We are seeking a detail-oriented and motivated Revenue Cycle Specialist to join our team. Under the direction of the Revenue Cycle Supervisor, the Revenue Cycle Specialist is responsible for a variety of revenue cycle functions, including charge entry, payment posting, A/R follow-up, and denials management in accordance with the center's policies and procedures. This role plays a key part in ensuring accurate financial processes, timely reimbursements, and overall operational efficiency.

Schedule: Full Time at our LaGrange location

Responsibilities

• Liaise with insurance providers to clarify patients' coverage and resolve disputes regarding rejected claims

• Thoroughly read and interpret EOBs to identify payment discrepancies

• Review and manage aging reports for assigned payors

• Communicate new or revised billing and coding guidelines to providers and their assigned specialties

• Make appropriate changes to incorrectly billed services, add missing unbilled services, provide missing data as needed, and correct CDT codes

• Confirm that the correct fee schedule is applied

• Collaborate with other operational areas to provide coding and reimbursement assistance; help identify and resolve incorrect claim issues; assist with drafting appeal letters as needed

• Post insurance payments and apply appropriate contractual write-offs

• Analyze and resolve complex accounts

• Communicate with patients regarding co-payments, insurance shortfalls, outstanding balances, and related billing issues

• Understand and explain dental and medical insurance plan benefits

• Effectively communicate with general dental offices, insurance companies, patients, and others regarding insurance benefits and procedure-related costs

• Handle multiple assignments and tasks simultaneously

Additional responsibilities may be assigned as needed

Qualifications

Requirements:

• High school diploma or equivalent

• Two years experience in billing/collections within a healthcare or dental setting

Preferred:

• Knowledge of dental and/or oral surgery operations

We Offer

• Competitive Compensation
• Benefits Package: Medical, Dental, Vision, 401K, Flexible Spending Accounts, Paid Time Off, Paid Holidays and much more!

Specialized Dental Partners, its affiliates, related companies and independently owned supported clinical practices are proud to be Equal Opportunity Employers. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

The salary range for this role is $23-$25 per hour. At Specialized Dental Partners, its affiliates, related companies and independently owned supported clinical practices, we are committed to ensuring fair and equitable pay for all employees. We adhere to all applicable federal, state, and local laws regarding pay equity and non-discrimination. Our compensation practices are designed to ensure that employees are paid fairly based on their role, experience, performance, and contributions to the company, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. We regularly review our compensation practices and conduct pay equity audits to identify and address any disparities. By fostering a culture of transparency and fairness, we aim to create an inclusive workplace where all employees feel valued and respected.

#LI-DNI

#LI-DNI

Cameo Dental Specialists

Responsibilities

The Revenue Cycle Specialist acts as one of the primary liaisons between Revenue Cycle Operations and the assigned service line in all Revenue Cycle matters. This includes, but is not limited to, providing, coordinating, and enabling timely access to accurate patient and financial information in order to provide various functional information in the most effective and meaningful format, as well as analyzing and validating Epic Reports needed for the assigned service line.

Qualifications

Required:

• Three years Revenue Cycle business; Three years reporting and analysis
• Bachelor Degree

Desired:

• EPIC Certification

Norton Healthcare

**Job Description**
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 also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. 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 will I 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. Primary duties include:
+ 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.
+ Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.
+ Keeps 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.
+ 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.
+ 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.
+ Attends specialty clinical huddles as requested and participates in group problem-solving.
+ Escalation of fee schedule discrepancies and system errors.
**Qualifications**
**Requirements:**
+ 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.
+ Follow-up collection experience sought.
+ Experience with workers' compensation a plus.
**Why work here?**
We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.
**Req ID** : 11583
**Working Title** : Revenue Cycle Specialist III
**Department** : CSRC PB - Group 4 Faculty
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Patient Billing
**Overtime Status** : NONEXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $25.06 - $38.84
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

**Job Description**
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 also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We provide an excellent benefits package that includes Health Care, paid time off and a 403(b). Discover why U.S. News & World Report has named us one of America's Best Hospitals!
**What will you be doing in this role?**
Under general supervision and following established practices, policies, and guidelines, provides Commercial and Government billing and collections support to Insurance Follow up and Accounts Receivable, performing duties which may include reviewing and submitting multi-specialty claims to third party payors, performing account follow-up activities, updating patient registration on accounts, etc. Positions at this level require expert knowledge, skill and proficiency in specialized functions and multiple 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, specialties, and provide back-up coverage.
In this role you will effectively bill, submit appeals and collect monies relative to physician reimbursements. You will be in charge of monitoring and processing accounts that are both straightforward or may need further research in order to bring resolution. You will work with minimal direction from management to ensure the integrity of the work performed. We work in a team environment to fulfill the mission and goals of the Department.
**Qualifications**
**Requirements:**
+ High school graduate or GED required.
+ Ability to read, write, understand and speak English effectively.
+ A minimum of three years professional/physician billing and/or Collection experience - CMS1500 experience a plus. This physician billing experience includes corresponding with patients and insurance companies in resolving patient accounts. Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements.
**Experience we are seeking:**
+ Expert knowledge of medical terminology and coding (ICD, CPT, HCPCS, Modifiers, procedure, bill type, diagnosis, and revenue codes).
+ Experience with MS office, Web/Vs, Availity and CS-Link preferred.
+ Expert knowledge of regulatory and CSHS policies and procedures. Basic understanding of HIPAA and other privacy information guidelines
+ Ability to perform business math.
+ Successful completion of PRMPT
1. + Ability to handle multiple tasks in a fast paced and high-volume environment with conflicting demands on time and attention. Ability to prioritize and organize work to complete assignments in a timely, accurate manner.
+ Minimum 3 years' experience in Commercial and Government billing and follow up. Office visits, procedures, outpatient and inpatient preferred.
+ Ability to interpret regulations for Commercial Ins, CMS or Medi-Cal
+ Professional and courteous demeanor.
**About Us**
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
**About the Team**
Cedars-Sinai is one of the largest nonprofit academic medical centers in the U.S., with 886 licensed beds, 2,100 physicians, 2,800 nurses and thousands of other healthcare professionals and staff. Choose this if you want to work in a fast-paced environment that offers the highest level of care to people in the Los Angeles that need our care the most.
**Req ID** : HRC
**Working Title** : Revenue Cycle Specialist II
**Department** : MNS PBS Huntington Hospital
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Patient Billing
**Overtime Status** : NONEXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $22.07 - $33.11
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

Job Description

Job Description

Salary: Competitive

Our successful subspecialty practice is growing and we have an immediate opening for a full-time Revenue Cycle Specialist.

The Revenue Cycle Specialist works as a part of the Business Office Team and will focus on obtaining patient benefit verification, prior authorizations, and accounts receivable. We're looking someone who is a fearless advocate for our patients and our practice.

The right candidate will have proven expertise in third-party payer requirements, in-depth insurance verification, prior authorizations and over-turning claim denials.

The Revenue Cycle Specialist, like the team they're joining, will be comfortable speaking with payers as well as patients.

We take pride in the fact that all of our internal teams work well with each other and in support of each other!

This position requires industry specific expertise and only those candidates with a background in medical billing can be considered.

Other Key Requirements:

• A proactive go-getter attitude
• Self-motivation and an enthusiasm for revenue cycle optimization
• A background which includes working with all payer types
• An understanding of charge entry and coding requirements
• Ability to speak with patients and explain benefits in an educative and compassionate manner.
• A background that demonstrates stability and reliability
• Desire to work as a part of team to achieve shared goals

We offer:

• Competitive salary
• Employer-contributed health plan, dental and vision plan
• Accrued Paid Time Off (PTO)
• We're closed for all major holidays including the Friday after Thanksgiving
• We offer an additional "Floating Holiday"
• We have an employer-matching 401k plan
• We offer bonus pay opportunities

We are an equal opportunity employer and do not discriminate based on race, religion, national origin, age, gender, disability or sexual preference.

To learn more about us, please visit our website at http:

**Job Description**
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 also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have high levels of employee engagement. We provide an outstanding benefit package that includes healthcare, paid time off, and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals.
**What will you be doing in this role:**
Under general supervision and following established practices, policies, and guidelines, outpatient billing and collections support, performing duties which may include reviewing and submitting claims to third party payors, performing account follow-up activities, updating information on account, etc. Positions at this level require expert knowledge, skill and proficiency in specialized functions and multiple 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.
**Qualifications**
**Requirements:**
+ High school diploma or GED required. College level courses in finance, business or health insurance preferred.
+ A minimum of 5 years revenue cycle experience to include hospital billing and/or collections experience required.
+ CPC preferred.
**Skills/Experience we are Seeking:**
Proven ability to handle multiple tasks in a fast-paced environment with conflicting demands on time and attention.
Superior decision-making, conflict resolution and critical thinking skills.
Demonstrated ability to interact effectively with directors, managers, patients, internal staff and representatives from outside agencies.
Excellent detail, analytical and problem-solving skills. Ability to quickly adjust to changing workflows.
Expert knowledge and understanding of regulatory and CSHS policies and procedures that govern billing and collections.
Ability to independently compose letters, policy statements, procedure manuals and reports.
Ability to organize complex statistical reports, charts, and exhibits into a complete document suitable for distribution.
Ability to think and work independently and with little supervision, prioritizing and organizing work to complete assignments in a timely, accurate manner. Uses good judgment for situations which require initiative and innovation.
**Why Cedars-Sinai?**
Beyond extraordinary benefits, paid time off, competitive salaries and health and dental insurance, we take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for
**Req ID** : 12305
**Working Title** : Revenue Cycle Specialist IV (Remote)
**Department** : CSRC PB - Group 3 CSMCF
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Patient Billing
**Overtime Status** : NONEXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $27.63 - $42.83
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

**Job Description**
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 also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. 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 will I 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. Primary duties include:
+ 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.
+ Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.
+ Keeps 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.
+ 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.
+ 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.
+ Attends specialty clinical huddles as requested and participates in group problem-solving.
+ Escalation of fee schedule discrepancies and system errors.
**Qualifications**
**Requirements:**
+ 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.
+ Experience billing for the Emergency Department preferred.
**Why work here?**
We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.
**Req ID** : 11794
**Working Title** : Revenue Cycle Specialist III (Emergency)
**Department** : CSRC PB - Group 7 ED
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Patient Billing
**Overtime Status** : NONEXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $25.06 - $38.84
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

**Job Description**
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 will I 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 Professional Fee billing and collections. Duties include 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 requires 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. 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 CS- Link 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:**
Analyzes, trends, reports out, and resolves pended claims in PB Claim Edit WQs and PB Payer Rejection Insurance Follow-up WQs to ensure clean claim submissions and timely reimbursement.
Completes special PB claims related projects as assigned. These projects could include trending issues to ensure workflow efficiencies and end user training opportunities, charge correct rebill projects, review and analysis of Retro WQ opportunities, rebill efforts for missing ICN, net down and write-off AR resolution needs (i.e. Provider not credentialed), and contacting payers as needed to ensure we have current claims logic and workflow understanding gaps covered to help support successful clean claim submissions.
Monitor and report PB clean claim submission opportunities that involve integration from CSLink Resolute to external vendors such as our clearinghouse and payers.
Familiarity with the ANSI X12 837 format used for electronic submission of professional healthcare claims. Understanding of the key segments, including:
+ ISA/GS/GE/ST Segments: Interchange control headers and functional group details.
+ NM1 Segments: Identification of patients, providers, and payers.
+ CLM Segment: Claim information, including billing details, service lines, and claim totals.
**Qualifications**
**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.
+ Professional billing experience in claims highly preferred.
**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.
**Req ID** : 9217
**Working Title** : Revenue Cycle Specialist III (Remote)
**Department** : CSRC PB - Group 3 CSMCF
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Patient Billing
**Overtime Status** : NONEXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $25.06 - $37.59
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.