- Information Technology
- Medical Network
Claims Auditor - Managed CareRequisition # HRC0337705 Apply Now
The Claims Auditor is responsible for working with the Managed Care Compliance Manager to ensure compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. Responsible for maintaining routine auditing functions and providing feedback on departmental activities to ensure ongoing compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Job Duties and Responsibilities:
- Evaluates claims adjudication using standard principles and state specific policies and regulations in order to ensure accurate and timely claims adjudication
- Performs moderately sophisticated claim audits on a routine basis for payment accuracy by following regulatory standards, and business policies
- Assist manager with validation of health plan findings
- Conducts quality assurance audits for claim adjustments, refunds and provider disputes
- Performs focused reviews and provides reports to the Compliance team
- Tracks and monitors all audit scores in database
- Assists in preparing audit reports as requested.
- High school diploma or GED required.
- Associates degree or college diploma preferred.
- Five (5) years of experience with adjudication of all types of claims preferred.
- Possess proven understanding of CPT, ICD, HCPCS, DRG coding, claims adjudication of hospital and professional claims and medical terminology.
- Experience with EPIC System preferred.
- Working Title: Claims Auditor - Managed Care
- Department: MNS - Managed Care
- Business Entity: Medical Network
- City: Encino
- Job Category: Finance
- Job Specialty: Accounting
- Position Type: Full-time
- Shift Length: 8 hour shift
- Shift Type: Day
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.
About Our Location
Encino, CaliforniaView Map