Offer summary

Qualifications:

Four years of experience in professional and facility claims processing for Medicare and Commercial products., Familiarity with provider dispute resolution and claims processing regulations., Knowledge of ICD-10, CPT-4, HCPC, Excel, Word, and EPIC Tapestry., Bachelor’s degree in Healthcare or a related field is preferred..

Key responsabilities:

Ensure accuracy of claims processing based on department policies and regulations.

Conduct detailed audits for compliance with State, Federal, and Health Plan requirements.

Document audit findings and present errors for corrections and analysis.

Monitor appeals and ensure timely processing of claims and related projects.

Job description

Job Description

Grow your career at Cedars-Sinai!

Cedars-Sinai Medical Center has been named to the Honor Roll in U.S. News & World Report’s “Best Hospitals 2024-2025” rankings. When you join our team, you’ll gain access to our groundbreaking biomedical research facilities and sophisticated medical education programs. We offer learning programs, tuition reimbursement and performance-improvement projects so you can achieve certifications and degrees while gaining the knowledge and experience needed to advance your career.

We take pride in hiring the best, most hard-working employees. Our dedicated doctors, nurses and staff reflect the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

What will you be doing:

The Claims Auditor is responsible for ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations.

Conducts detailed audits for compliance with State, Federal and Health Plan regulatory requirements.
Conducts pre and post payment audits on adjudicated claims in compliance with Cedar-Sinai policies, procedures and payment methodologies.
Documents audit findings and presents errors to Claims Operations for corrections, root cause analysis and appropriate resolution.
Provides analysis and prepares recommendations to Management for errors and inconsistences.
Provides process improvement suggestions to Management.
Monitor appeals from providers, members and health plans to make sure they are processed accurately and in timely manner.
Monitors the daily auditing of processed claims and letters for accuracy.
Distributes and monitors multiple projects to make sure deadlines are met.

Qualifications

Experience Requirements:

Four (4) plus years of professional and facility claims processing for Medicare and Commercial products. Must be familiar with provider dispute resolution. (preferred)

Knowledge of claims processing, ICD-10, CPT-4 and HCPC, Excel, Word, and EPIC Tapestry along with CMS and DMHC regulations for compliance.

Education Requirements:

High School Diploma/GED.

Bachelor’s degree in Healthcare or related field of study, preferred.

Req ID : 7494

Working Title : Claims Auditor (Managed Care) - Remote

Department : MNS Managed Care

Business Entity : Cedars-Sinai Medical Center

Job Category : Finance

Job Specialty : Accounting

Overtime Status : NONEXEMPT

Primary Shift : Day

Shift Duration : 8 hour

Base Pay : $25.88 - $38.82

Required profile