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.

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.??

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Education Requirements:

High School Diploma/GED.

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