- Coordinate and follow through on the reimbursement activity for specific patient accounts (e.g. Multi-specialty areas including, but not limited to, Ob/Gyn, Hematology/Oncology, Cardiology, Orthopaedic, Urology, Neurology, Transplant cases, etc).
- Initiates proactive measures that result in account resolution.
- Ensures all conditions for payment receipt have been satisfied, which includes, but not limited to:
accurate financial class
ICD-10 coding, as applicable
CPT-4 coding, as applicable
patient benefit coverage
patient insurance eligibility
- Responds timely and accurately to all incoming related correspondence and inquires from payers, patients and other authorized parties. Reports any trends in incoming correspondence to managers for appropriate follow-up.
- Interacts with co-workers and other representatives to obtain required information on a timely basis.
- Initiates contact with patients as necessary
- Initiates recommendations and actions for resolving patient accounts. Evaluate accounts to determine any write-offs or corrections required, including duplicate charges.
- Submit bills to insurance for secondary insurance.
- Ensure that all necessary documentation and information is correct according to departmental policies and procedures. Ensure that all documentation is complete for submission to determine ultimate action on patient account.
- Ensure that all applicable monies are transferred from the hospital so that they may be posted accordingly.
- Answer telephones, patient inquiries, and respond appropriately to written correspondence relative to a patient's account.
- Research and prioritize incoming mail, resubmit denials with proper documentation according to departmental policies and procedures.
- Verify correct initial subscriber billing information and update information in the system as necessary.
- Prepare refund request for any or all monies due to patient or insurance company as a result off overpayments or forward requests to appropriate individual in charge of processing refund requests.
- Post adjustments to accounts in accordance with departmental policies and procedures.
- Respond to all phone calls from other departments or insurance companies in an efficient and courteous manner.
- Demonstrate teamwork and provide assistance with special projects when assigned.
- Create correspondence and provide documentation for effective reimbursements.
- Responsible for updating information within the Epic system (charges, adjustments, write-offs, bad debt, refunds to patients/insurance companies, and professional courtesies). Responsible for processing non-sufficient funds checks and ensure follow-up with those patients in these categories.
- Clearly document within the patient's account, actions taken on the account and any other follow-up that was done, including what the expected outcome should be.
- Trains co-workers on advanced or specialized client and billing procedures, as needed.
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.