The Biller/Collector Specialist. CPC is responsible for timely, appropriate billing and collection of monies from Payors on specialized and complex accounts. This position is responsible for providing advanced, high-caliber problem identification and resolution as it pertains to billing, collections, as well as coding.
Job Duties and Responsibilities:
- Follows-up on all assigned accounts within the system work queues in accordance with pre-established goals
- Initiates proactive measures that result in account resolution on assigned projects involving specialized or complex issues
- Researches and analyzes denied, outstanding accounts and payments for the appropriate action and resolution
- Ensures that all conditions for payment receipt have been satisfied, which includes, but is not limited to accurate charges and financial class; authorization/certification/TAR requirements; claims address; ICD-10 and CPT-4 coding; patient insurance eligibility; accurate VFO (visit filing order) when appropriate; patient benefit coverage; patient responsibility
- Responds timely and accurately to all incoming correspondence and inquiries from Payors, patients and other pertinent parties; handles all correspondence, documentation and files in a professional and confidential manner
- Responds to all phone calls from other departments or insurance companies in an efficient and friendly manner
- Reviews various reports to identify denials and edits; corrects claims if needed; share feedback and/or action plans to eliminate these denials/edits in the future; determines appropriateness for appeals
- Reviews the insurance coding denials for their assignment, as well as other areas in the Specialist Coding work queues, to make the appropriate coding recommendations for charge corrections, write offs or appeals as needed
- Details the appropriate notes for every account worked, including any action(s) taken and/or a summary of issues addressed; maintains appropriate documentation of all denials, system issues and projects
- Evaluates accounts to determine any write-offs or corrections required, including the research of duplicate charges as needed
- Initiates recommendations and action plans for resolving accounts to operations and client management
- Prepares refund requests for any monies identified as a duplicate, erroneous or overpayment due to the patient or insurance company
- Works on special accounts/projects as requested by management; train on the development of junior staff as needed
- Works with team members within Physician Billing Services and other departments to acquire the required information on a timely basis to resolve outstanding issues, as appropriate
- Shares coding feedback and recommendations with the Biller/Collectors I – III, as appropriate
High school diploma or GED required.
Certified Professional Coder (CPC) required.
Five (5) years of experience required in the following:
- Experience in a large billing/collection office
- Extensive experience with the Epic system, Outlook, Excel and Word
- Knowledge of CPT-4 and ICD-10 coding and reimbursement guidelines
- Strong data analysis skills
- Strong knowledge of all Payor types
- Ability to handle complex accounts
- Working Title: Biller / Collector Specialist, CPC - Billing Services
- Department: MNS Physician Billing Ofc
- Business Entity: Medical Network
- City: Torrance
- Job Category: Patient Financial Services
- Job Specialty: Patient Billing
- 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.
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