Facility Outpatient Surgical and Claims Edit Auditor (Remote)

MedicalVirtual; Los Angeles (CA); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Paid vacation

403(b)

Job summary

Cedars-Sinai in Los Angeles seeks a Coding Auditor to review encounters and validate coding profiles in prebill or retrospective workflows. You will assess adherence to coding references, local, state, and federal guidelines, and provide actionable summaries.

Responsibilities include quality audits, post-audit corrections, and 1:1 or small group feedback sessions to improve accuracy, data quality, and billing outcomes across departments.

Qualifications

• Requires 3+ years of Coding Audit experience with billing/coding accuracy.
• Experience with internal coding policies and external guidelines helpful.
• CCS, CPC, RHIA or RHIT certification required upon hire.

Responsibilities

• Review encounters in prebill or retrospective workflow to validate coding profiles.
• Evaluate compliance with AHA/AMA coding references and state/federal guidelines.
• Produce written summary reports and lead feedback sessions.
• Assist in improving data quality for reporting and reimbursement.
• Support paging and rounding out with career-wide education sessions.

Skills

Auditing

Coding accuracy

Data quality

Communication

Education

Health Information Management degree

High school diploma or GED

CCS, CPC, RHIA or RHIT certification

Job description

Los Angeles, California, Job Description Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an extraordinary benefits’ package and competitive compensation. Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

What will I be doing in this role?

The Coding Auditor works under the general direction of the Coding Supervisor. A Coding Auditor is responsible for reviewing encounters in either a prebill or retrospective workflow to validate a coding profile. This includes applicable code sets to encounter type, abstracted data elements, missed query opportunities, and other related encounter data collection points. Auditors evaluate compliance with all coding guidelines including but not limited to: Internal Coding policies/procedures/handbook, American Hospital Association (AHA) and American Medical Association (AMA) coding references, local, State, and Federal Coding Guidelines. Duties include: Performs quality coding reviews or audits within established departmental productivity and accuracy standards. Assists with processing re-bills post coding audit changes and assists with coding corrections needed from billing department. Provides written summary reports of findings. Coordinates and leads 1:1 or small group feedback sessions based on recommendations Maintains appropriate 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 shortage of staff. Assist in improved data quality for reporting and research, accurate billing and reimbursement of services rendered which overall improves the quality of care for the patient. Provide 1:1 and small group education sessions, facilitate round table discussions, contribute content to the coding newsletter, provide basic level trending or data review for opportunities. Evaluate codes through data reports and trended opportunities, audit to validate findings, produce summary reports with recommendations of action plans. Perform additional activities (e.g. Data quality reports, etc.) as assigned by the Coding Supervisor.

Qualifications Requirements:

High school diploma or GED required. Degree in Health Information Management preferred. A minimum of 3 years of Coding Audit experience with auditing skills covering coding/billing accuracy of coding staff required. CCS, CPC, RHIA or RHIT required upon hire. Facility outpatient surgical claims experience highly preferred.

Why work here?

Beyond outstanding employee benefits including health and dental insurance, paid vacation, and a 403(b), we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.

Source