Revenue Cycle Specialist III (Orthopedics)

Cedars-Sinai; Los Angeles (CA); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Outstanding benefit package

Paid time off

403(B) plan

Competitive compensation

Job summary

Cedars-Sinai is seeking a Revenue Cycle Specialist III to manage hospital billing and collections. This role requires close collaboration with clinical departments and expertise in revenue cycle management.

The ideal candidate will have a minimum of 4 years in professional billing, strong CPT and ICD-10 knowledge, and will contribute towards enhancing operational efficiencies. A dynamic and inclusive work environment awaits you!

Qualifications

• 4+ years of hospital revenue cycle billing experience required.
• Professional billing experience highly preferred.
• Orthopedics experience is a plus.

Responsibilities

• Submit claims to payors and perform account follow-ups.
• Maintain relationships with clinical departments and clients.
• Input charges and direct billing appropriately.
• Initiate collection calls for unresolved balances.

Skills

Revenue cycle management

Expert knowledge in billing

Patient communication

CPT and ICD-10 knowledge

Education

High School Diploma or GED

College level courses in finance, business or health insurance

Job description

Job Description

Align yourself with an organization that has a reputation for excellence! Ranked as No. 1 Workplace by Indeed.com, we also were awarded the Advisory Board Company’s Workplace of the Year. This recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefit package that includes paid time off, health care and a 403(B) along with competitive compensation. Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

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 the 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.

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.

Why work here?

Beyond outstanding employee benefits 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.