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Clinical Research Billing Specialist IIRequisition # HRC0331153 Apply Now
Join Cedars-Sinai and become part of a team that is at the forefront of medical advancements. Work alongside physician-scientists and researchers who are making life-saving medical and scientific breakthroughs. Our team of researchers develop some of the most advanced clinical trials in the world. Here, you will be a part of leading-edge cancer research history that improves and enhances our patients' treatment options, one trial at a time.
The Cancer Clinical Trials Office (CCTO) staffed by highly trained professional research personnel (research nurses, clinical research coordinators and clinical research associates), is a central office that provides the infrastructure and function for operations of Cancer Clinical Trials at Cedars-Sinai Cancer, including its medical network and health system, which at any given time has approximately 140 cancer clinical trials. CCTO resources are available to both faculty and industry sponsors to assist throughout the lifecycle of a protocol, from inception to study closeout. We are the central point of contact who coordinates with investigational pharmacy, laboratory, nursing, the National Cancer Institute (NCI) and other collaborating academic institutions.
Join the CCTO as a Clinical Research Billing Specialist II by improving revenue capture accuracy as a result of: responding to payor denial notifications by analyzing CSMC commercial contracts and reconciling to payments received; providing all required appeal documentation and follow-up for the successful collection of denied items/services; accurately and consistently documenting the results of all denial and subsequent approvals in the hospital information system; effectively utilizing all internal automation and software applications; preparing reports as required by management regarding denial appeal results, process improvement recommendations and systemic denial patterns, and providing monthly observations and recommendations to prevent future cash losses from payor denials. Must be able to identify, analyze and present corrective actions and systemic improvements that are generating / contributing to CSMC cash losses and/or PFS re-work. Required to quantify and present recommendations to groups of CSMC employees, supervisors and/ or managers.
In addition the Clinical Research Billing Specialist II will be responsible for the following:
- Analyzes and reconciles payments received against CSMC commercial contracts.
- Conducts timely and effective follow-up to successfully collect all underpaid and denied accounts with insurers and responsible parties.
- Accurately documents audit results and collection efforts in hospital information system.
- Keeps management apprised of collection progress and payer payment practices outside the terms of the governing contracts. Escalates accounts for legal action “post exhaustion of the dispute process” to management
- Utilizes all department automation and software applications. Prepares management reports.
- Possess and demonstrate comprehensive knowledge of CSMC commercial contracts including all terms and governing provisions, i.e., timing filing, appeal and dispute process, reimbursement rates and condition/ qualifiers for each reimbursement tier.
- Maintain current knowledge of Federal and State rules and regulations, updates and changes related to health care revenue collections.
- Observes and recommends process improvements to reduce systemic payment errors and prevent future cash losses from contract payment variances.
- Performs special tasks and projects as assigned.
- High school diploma or GED, required
- Seven (7) years or more hospital billing and collections experience.
- Computer literacy, interaction and keying skills; full competency in MS Office.
- Ability to interact with, understand and update applications used to manage accounts and to access alternative information sources.
- Knowledge of basic accounting principles and healthcare billing and collection practices.
- Ability to interpret and discuss insurance explanations of benefits and payments.
- Able to perform complex mathematical calculations.
- Able to use correct forms, codes, etc., to process and document work.
- Demonstrated ability to prioritize and organize work and complete assignments in a timely and accurate manner.
- Working Title: Clinical Research Billing Specialist II
- Department: SOCCI Clinical Research Office
- Business Entity: Academic / Research
- City: Beverly Hills
- Job Category: Academic/Research
- Job Specialty: Contract & Grant Budgeting/Funding
- Position Type: Full-time
- Shift Length: 8 hour shift
- Shift Type: Day
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. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org 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). 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 March each year) as a condition of employment, and annually thereafter as a condition of continued employment.
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