Facility Inpatient Surgical and Claims Edit Auditor

Cedars-Sinai; Los Angeles (CA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Health care

Dental insurance

Paid vacation

403(b) retirement plan

Job summary

A leading healthcare institution in Los Angeles seeks a Coding Auditor to review and validate coding profiles in compliance with guidelines. Responsibilities include conducting coding audits, processing re-bills, and providing education. Candidates should have a high school diploma or GED, 3 years of auditing experience, and certifications like CCS or CPC. This role offers extensive benefits, including healthcare and retirement plans. Remote work approved from certain states, including California.

Qualifications

• High school diploma or GED required; a degree in Health Information Management preferred.
• Minimum of 3 years of Coding Audit experience with auditing skills covering coding/billing accuracy.
• Required certifications upon hire: CCS, CPC, RHIA, or RHIT.

Responsibilities

• Perform quality coding reviews or audits.
• Assist with processing re-bills post coding audit changes.
• Provide written summary reports of findings.
• Coordinate feedback sessions based on recommendations.
• Maintain communication with internal and external partners.
• Assist with production coding during staff shortages.
• Improve data quality for reporting and research.
• Provide education sessions and contribute to coding newsletter.
• Evaluate codes and produce summary reports with recommendations.
• Perform data quality reports as assigned.

Skills

Coding Audit experience

Auditing skills

Communication

Analytical skills

Education

High school diploma or GED

Degree in Health Information Management

Tools

Coding software

Job description

Job Description

The Coding Auditor works under the general direction of the Coding Supervisor and is responsible for reviewing encounters in either a pre-bill or retrospective workflow to validate coding profiles. The role includes verifying applicable code sets, abstracted data elements, missed query opportunities, and other related encounter data collection points. Auditors evaluate compliance with all coding guidelines, including internal policies, AHA and AMA coding references, and local, state and federal coding guidelines.

Responsibilities

• Perform quality coding reviews or audits within established departmental productivity and accuracy standards.
• Assist with processing re-bills post coding audit changes and with coding corrections needed from the billing department.
• Provide written summary reports of findings.
• Coordinate and lead 1:1 or small group feedback sessions based on recommendations.
• Maintain open communication with internal and external partners and peer departments such as Coding Operations, Clinical Documentation Integrity (CDI), Payor Revenue Management (PRM), and Compliance Revenue Integrity (CRI).
• Assist peer departments with production coding of cases during staff shortages.
• Improve data quality for reporting and research, ensuring accurate billing and reimbursement of services rendered, which overall improves patient care quality.
• Provide 1:1 and small group education sessions, facilitate round table discussions, contribute content to the coding newsletter, and provide basic level trending or data review for opportunities.
• Evaluate codes through data reports and trend opportunities, audit to validate findings, and produce summary reports with recommendations of action plans.
• Perform additional activities such as data quality reports as assigned by the Coding Supervisor.

Qualifications

• High school diploma or GED required; a degree in Health Information Management preferred.
• Minimum of 3 years of Coding Audit experience with auditing skills covering coding/billing accuracy of coding staff.
• Required certifications upon hire: CCS, CPC, RHIA, or RHIT.
• Facility inpatient surgical claims experience highly preferred.

Benefits

Benefits include health care, dental insurance, paid vacation, and a 403(b) retirement plan.

Remote Eligibility

Approved remote states: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas.