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
Our compensation philosophy
We offer competitive total compensation that includes pay, benefits, and other recognition programs for our employees. The base pay range shown above takes into account the wide range of factors that are considered in making compensation decisions including knowledge/skills; relevant experience and training; education/certifications/licensure; and other business and organizational factors. This base pay range does not include our comprehensive benefits package and any incentive payments that may be applicable to this role. Pay Transparency Non Discrimination Provision (PDF) (opens in new window)
Diversity and Inclusion at Cedars-Sinai
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve – because that’s what our patients, colleagues and communities deserve. Quality Care and Research—For All, By All (opens in new window).
Cedars-Sinai is an Equal Employment Opportunity 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. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy. Cedars-Sinai’s AA Policy Statement (PDF) (opens in new window)
