Physician Coding & Compliance Auditor — Impact

Cedars-Sinai; Los Angeles (CA); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Paid vacation

Wellness initiatives

403(b)

Job summary

Cedars-Sinai in Los Angeles is seeking a Physician Compliance Auditor to review claims, medical records, and charges for compliance with documentation, coding, and billing rules. You will educate providers and staff, deliver audit results via Teams or other remote meetings, and act as a subject matter expert on coding and documentation guidelines.

This role collaborates with the Manager of Audit and Compliance to identify risks, present findings to leaders, and maintain accurate audit records,

Qualifications

• High school diploma or GED required.
• Bachelor's degree preferred.
• Certified Professional Coder certification required upon hire.
• Minimum of 2 years of professional fee coding/auditing experience.

Responsibilities

• Perform physician compliance audits and group audits by analyzing medical record documentation and coding services for compliance with policies.
• Identify areas of risk or non-compliance and provide actionable recommendations.
• Educate and train providers on audit findings, regulatory requirements, and feedback.
• Summarize audit results and present to providers, operations leaders, and leadership.
• Prepare reports and communicate audit results to management and clinicians.
• Develop training materials as a subject matter expert.
• Maintain audit activity in software/spreadsheets and provide regular reporting.

Skills

Audit & coding knowledge

Provider education

Education

Certified Professional Coder (CPC)

Bachelor's degree preferred

Job description

Job Description

Align 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. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

What you will be doing in this role:

The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated with documentation, coding, and billing. This position is responsible for maintaining expert knowledge and understanding of coding and documentation guidelines. Collaboration with the Manager of Audit and Compliance and others where expertise in compliant coding and documentation is needed. In this role your duties will include:

• Performs physician compliance audits and group audits by analyzing medical record documentation and coding services to ensure compliance with government and organizational policies and procedures.
• Identifies areas of risk and/or non-compliance and provides recommendations for action - advances as needed.
• Conducts education and training sessions with individual providers on audit finding results, regulatory requirements and provide actionable feedback for improvement.
• Responsible for summarizing audits results and presenting to provider, operations leaders, and other leadership.
• Communicates feedback directly to providers.
• Prepares necessary reports and communicates audit results to management and clinicians.
• Prepares training and education materials acting as subject matter expert.
• Tracks, records, and maintains audit/review activity in software or excel spreadsheets.
• Provides regular and ad hoc reporting.
• Assists with audit & compliance related special projects as requested.
• Maintains a high level of competency related to medical record documentation, coding and compliance with government regulations by attending appropriate workshops and seminars.
• Monitors Medicare and regulatory agencies rules for updates and changes and supports Cedar-Sinai’s core values and procedures.
• Acts as a professional liaison for physician compliance related activities, in a professional and confidential manner.

Qualifications

Requirements:

High school diploma or GED required. Bachelor's degree preferred.

Certified Professional Coder certification required upon hire.

A minimum of 2 years of professional fee coding/auding required, preferably in an academic medical setting.

Why work here?

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 commitment to creating a dynamic, inclusive environment that fuels innovation.