The Biller/Collector Specialist, CPC is responsible for timely, appropriate billing and collection of monies from Payors on specialized and complex accounts. In addition, differentiating the Biller/Collector Specialist role from that of the Biller/Collectors I-III, this position is responsible for providing advanced, high-caliber problem identification and resolution as it pertains to billing, collections, as well as coding.
Follows-up on all assigned accounts from within the Epic 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; correct 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 courteous 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
Documents the appropriate notes within the Epic system 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 obtain 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
Establishes effective working relationships with cross-functional team(s)
Cultivates and maintains strong customer relationships and rapport with stakeholders and/or client groups
Identifies and responds appropriately to both internal and external customer needs utilizing available resources.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.