Cedars-Sinai Biller/Collector II in Torrance, California
Job Posting: The Biller/Collector is responsible for timely and appropriate billing to and collection of monies from payors and/or patients. Follows-up on all assigned accounts from within the Epic (CS-Link) systems in accordance with pre-established goals. Initiates proactive measures that result in account resolution. Researches and analyzes accounts and payments; reverses balances to credit or debit if charges were improperly billed or if payments were incorrect. 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 information; claims address; ICD-9 and CPT-4 coding; patient insurance eligibility, patient benefit coverage; patient responsibility. Responds timely and accurately to all incoming correspondence and inquiries from payers, patients, and other appropriate parties. Initiates contact with patients, as necessary. Initiates recommendations and action plans for resolving accounts. Evaluates accounts to determine any write-offs or corrections required, including duplicate charges. Submits claims for secondary payment. Prepares refund requests for any monies due to patient or insurance company. Responds to all phone calls from other departments or insurance companies in an efficient and courteous manner. Writes appropriate notes in Epic for every account, including any action taken. Handles in a professional and confidential manner all correspondence, documentation, and files. Reviews various reports to identify denials and edits; corrects claims; suggest action plans to eliminate these denials/edits in the future; determines appropriateness for appeal. Prepares write-offs requests for denied claims which cannot be appealed. Attempts to locate patient/guarantor through direct contact, letter, or other means. Speaks with patient/guarantor to find third party sponsorship, settlement, or to begin charity process. Investigates the possibility of Medi-Cal linkage. Establishes payment arrangements according to pre-set guidelines. Prepares correspondence to patient/guarantor, as necessary. Receives and answers inquiries or complaints concerning self-pay accounts; gathers information for timely resolution of issues. Elevates issues, as appropriate, to the Supervisor. Meets daily and weekly productivity standards. Supports CSMNS core values, policies, and procedures. Customer Service: Applies resolution to patient calls based on established standards and procedures. Interprets billing questions and provides clarification. Listens and responds to customer service needs with the appropriate level of urgency. Develops and maintains rapport with insurance payers, outside agencies, Cedars-Sinai Medical Center, and Cedars-Sinai Medical Network Services. Adjusts patient accounts as appropriate, based on the Explanation of Benefits. Updates patient accounts based on verified information from the patient/guarantor. Prepares correspondence to patients and insurance payers, as necessary. Records appropriately detailed notes in Epic and PCS. Elevates issues, as appropriate, to the Supervisor. Meets daily and weekly productivity standards. Supports CSMNS core values, policies, and procedures. Communication: Meets with Supervisor weekly. Works with co-workers in PBS and others to obtain required information on a timely basis and to solve outstanding issues, as appropriate.
Education Certifications/Licensure Experience Physical Abilities High school Diploma or equivalent.
Familiarity with computer system usage; Epic experience preferred.
Understanding of insurance billing and collection requirements.
Familiarity with CPT-4 and ICD-9 coding.
Knowledge of procedures and data flow in a healthcare organization; experience with physician billing preferred.
Excellent verbal and written communication skills in the English language.
Able to work in team-oriented environment.
Some knowledge of insurance types, such as HMO, PPO, etc.; familiarity with specialty coding; 2 or more years experience; assertiveness in collections; needs minimal supervision.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift/or move up to 25 pounds. Specific vision abilities by this job include close vision, color vision, and ability to adjust focus.