"Revenue Cycle Specialist III (Pathology)"

Job Description

Bring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals 2024-25" rankings, and it's all thanks to our team of 14,000+ remarkable employees.

What will I be doing in this role?

The Revenue Cycle Specialist III works under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Hospital, Professional Fee billing and collections. Submit clean, accurate claims to payors and perform timely follow-up to resolve outstanding balances. Positions at this level require expert knowledge, skill and proficiency in CS-Link functions and multi-specialty areas of the revenue cycle. Incumbents have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same. Incumbents are expected to research, analyze and resolve complex cases and problem accounts with minimal assistance. Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor. This position may be cross-trained in other revenue cycle functions and provide back-up coverage. Primary duties include:

Develops and maintains excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients, performing duties that include identifying, analyzing, resolving, and responding to our client’s inquiries, concerns, and issues, and following up on accounts to ensure resolution. Serves as liaison between CSRC Services and Clinical Departments in the coordination of billing and reimbursement. Responds to patient, insurance company, and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution.

Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.

Keeps informed of rules and regulations affecting coding and reimbursement by maintaining current CPT and ICD-10 knowledge of assigned areas for accurate assessment of charge review.

Inputs specialty or cosmetic charges, creates manual invoices and follows up for payment. Directs billing to the correct entity i.e. (Vision Plan, Personal Family, or Non-Covered). Distributes payments to avoid inaccurate billing to patients. Discusses cash pricing for cosmetic services and cash packages with patients and manages credits for package and/or cosmetic services.

Identifies and advances new services for appropriate pseudo-code creation.

Identifies possible coding deficiencies through charge/medical record review and coordinates coding review to ensure accurate charge capture, enhancing third-party reimbursement and minimizing audit liability.

Review accounts on OCS report with providers to identify balances approved or declined for further collection activity. If approved, initiate collection calls to patients to collect on unresolved balances. If declined, set notification in OCS report format to ensure the account is routed to the appropriate work queue for final resolution.

Attends specialty clinical huddles as requested and participates in group problem-solving.

Escalation of fee schedule discrepancies and system errors.

Participate in specialty clinical huddles and problem-solving discussions.

Research and resolve denied or underpaid claims; prepare and submit timely, accurate written appeals with supporting clinical / billing documentations in accordance with payer guidelines.

Maintain detailed documentation of appeal activity in Epic, ensuring compliance with internal policies and audit readiness.

Qualifications

Requirements:

High School Diploma or GED required. College level courses in Finance, Business or Health Insurance preferred.

Minimum of 4 years of professional and/or hospital revenue cycle billing experience required. Professional billing experience highly preferred.

Experience in Pathology preferred.

Ability to review and interpret medical documentation, including progress notes, lab results, pathology reports, and other clinical records, to support accurate billing, appeals, and charge validation.

Please provide volume of cases worked.

Why work here?

Beyond outstanding employee benefits (including health, vision, dental and life and insurance) we take pride in hiring the best employees. Our accomplished and compassionate staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.