Revenue Cycle Specialist IV – Commercial and Government Credits/Refunds

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. Primary duties include:

• Customer Service: Independently responds timely and accurately to all requests. Interacts professionally and courteously with employees and internal and external customers.
• Communication: Effectively communicates, in writing and verbally, with employees and internal and external customers. Actively participates in department meetings and provides feedback to management on how to improve department processes. 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 logical. Written communication (email, etc.) is appropriate for level being addressed.
• Time Management: Effectively manages time. Maintains a clean and orderly workstation. Prioritizes work activities consistent with department goals and can balance daily workload and several projects.
• Professionalism: Exemplifies high standards of professionalism, responsibility, accountability and ethical behavior. Participates in continuing education activities and promotes a positive and productive working environment. Engages in performance improvement activities within the department. Able to multi-task effectively and is flexible with priorities. Adapts and modifies practices and routines when advised of need to do so and does so with a positive attitude. Takes initiative independently. Self-directed and able to work independently and rarely needs to consult management or co-workers. Volunteers and accepts special projects and assignments.
• Compliance: Applies detailed knowledge of and complies with all hospital and department policies, procedures (e.g., PHI). department specific systems and utilizes them effectively and efficiently. Participants in ongoing education to improve skill.
• Work queue/Workload: Effectively monitors assigned work queues and workload, ensuring resolve of accounts in a timely and accurate manner. Manages workload and priorities to meet deadlines. Takes initiative on issues and/or problems achieving desired results with minimal instruction. Notifies supervisor of issues and/or problems outside scope of authority per department standard.
• Job Aids: Understands and follows all applicable job aids and processes for unit. Applies “TCR” Touch It, Claim It, Resolve It.
• Account Documentation/Data Entry: Adheres to documentation standards of the department. Properly uses activity codes. Notes are clear and concise. Correctly enters data in fields. Maintains acceptable levels of speed and accuracy.
• Account Review/Resolution: Demonstrates expert knowledge of payor practices, policies and procedures as well as the initiative and ability to problem solve in accomplishing departmental objectives. Monitors payment status of assigned accounts. Independently initiates dialogue with payor and/or patient to ensure resolution of accounts (e.g., responds to additional documentation requests, refers denied accounts to supervisor for advisement on appropriate action). Effectively and efficiently manages account inventory and ensures timely resolution and closure of accounts

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.
• A minimum of 5 years of experience with Government Credits and/or Commercial Credits highly 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.

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.

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

: 182

Working Title

: Revenue Cycle Specialist IV – Commercial and Government Credits/Refunds

Department

: CSRC PB – Group

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

: $26.31 – $40.78

Cedars-Sinai is an Equal Employment Opportunity 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. If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy. Cedars-Sinai’s AA Policy Statement (PDF) (opens in new window)