The Biller/Collector is responsible for timely and appropriate billing to and collection of monies from payors and/or patients. Position will work in the payment department with the remit team assisting with many tasks such as locating payments, reconciling electronic remittance, EFT and ERA enrollment, wire transfers, reconciling bank reports and working remit work queue's. Claims and remit experience.
Job Duties and Responsibilities:
Follows-up on all assigned accounts from within the IDX/PCS 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 needed
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 friendly manner
Writes appropriate notes in IDX 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; captures information for timely resolution of issues
Elevates issues, as appropriate, to the Supervisor
Meets daily and weekly efficiency standards
Ability to understand the concept and how to post PLB's
Understand 837 and 835 files
Ability to work claim rejections within PMS and Clearinghouse
Education:
High school diploma or GED required.
Experience:
Three to five (3-5) years experience performing medical billing functions / Health Care Revenue Cycle payments and claims. Claims and remit experience.
Minimum experience includes corresponding with patients and insurance companies in resolving patient accounts
Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements. Analytical understanding of payor EOB/ERA's.
Experience with online Accounts Receivable billing systems (Epic system experience a plus). Knowledge of PC based software applications (e.g. Outlook, Word, Excel, etc.).
Working Title: Biller / Collector ll - Billing Services
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.
