Remote Inpatient Surgical Claims Auditor

Cedars-Sinai; Los Angeles (CA); Hybrid; 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

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 annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We provide an outstanding benefit package that includes health care, paid time off and a 403(B). 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 inpatient 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.

*Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas*

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