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Job Description

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company’s Workplace of the Year. We provide an outstanding benefit package that includes healthcare, paid time off and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

What you will be doing in this role:

The Team Lead oversees the Collections and Denials Management unit. Responsible for handling the day-to-day departmental operations, assigning and reviewing work assignments for staff members. Team Lead must have extensive knowledge and understanding of regulatory requirements, payor contracts and Cedars-Sinai policies governing billing and collections and sound interpretation. The Team Lead will perform duties which include identifying, analyzing, resolving and responding to inquiries, concerns and issues, and following up on accounts to ensure payment and resolution.

+ Monitors, evaluates, and reviews Cedars-Sinai Managed Care contracts and reconcile to payments received.

+ Ensures appropriate insurance coverage and successfully collect underpayments from insurance carriers.

+ Analyzes and validates reimbursement for denied claims. Accurately and consistently document the results of all audits and subsequent adjustments in the hospital information system.

+ Identifies systemic payment errors and make process improvement recommendations to assure the highest revenue recovery possible.

+ Oversees the major payer escalation log for trending, reconciling and submission on a monthly basis; Able to assist management with special projects and participates on Payer Joint Operating Committee (JOC) meetings.

+ Completes all necessary research and account follow-up activities to resolve inquiries. Ensures that the resolution completed meets the department's standards.

+ Collaborates with Supervisor and EIS to open tickets to load, fix and test managed care contracts.

+ Performs payer discrepancies analysis and prepare documentation for payer escalation or litigation as necessary.

+ Monitors assigned work queues and workload, ensures resolution of accounts in a timely and accurate manner. Takes initiative on issues and/or problems by advancing them to supervisor; has the ability to diffuse these issues.

+ Resolves assigned work queues accounts and completes account follow-up activities including: obtaining claim status, responds to insurance company and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution.

+ Assumes lead role in the absence of the Supervisor or Manager. Assist in the training of staff on Cedars-Sinai policies and procedures. Assists management with updating policies, procedures and job aids as assigned.

Qualifications

Requirements:

•High school diploma or GED required. Bachelor’s degree in accounting, finance, business administration, hospital administration or another related major preferred.

•Minimum of 5 years of hospital billing and/or collection experience; Denials Management and Managed Care Contracts required.

•Minimum of 5 years of Experience with UB04 claim form, medical terminology and coding (ICD, CPT, HCPCS, bill types, diagnosis and revenue codes) preferred.

•Minimum of 2 years of experience with Managed care contract interpretation and reimbursement analysis preferred.

Why work here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.

**Req ID** : 11322

**Working Title** : Team Lead Collections

**Department** : CSMC 8550000 CSRC HB Follow Up

**Business Entity** : Cedars-Sinai Medical Center

**Job Category** : Patient Financial Services

**Job Specialty** : Revenue Integrity

**Overtime Status** : NONEXEMPT

**Primary Shift** : Day

**Shift Duration** : 8 hour

**Base Pay** : $29.87 - $46.30

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.