The Biller/Collector III efficiently and effectively bill and collect monies relative to physician reimbursements. Works on specific types of accounts (e.g. transplant cases, cardiothoracic surgeries and other advanced type of special accounts, Prop 99, etc.) in a team environment to fulfill the mission and goals of the Department.
Job Duties and Responsibilities:
Coordinate and follow through on the reimbursement activity for specific patient accounts (e.g. Multi-specialty areas including, 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 charges
- patient insurance eligibility
- accurate financial class
- patient benefit coverage
- authorization/certification/TAR information patient responsibilities
- claims address
- CPT-4 and ICD-10 coding, as applicable
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 action.
Interacts with co-workers and other representatives to acquire 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.
Ensures necessary documentation and information is accurate and 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.
Research and prioritize incoming mail, resubmit denials with accurate documentation.
Verify 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.
Respond to all phone calls in an efficient and courteous manner.
Demonstrate collaboration 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 details 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 t...eaching 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.