What are the responsibilities and job description for the Claims Auditor (Managed Care) position at Cedars-Sinai?
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)
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
Salary : $26 - $39
