Claims Auditor, Managed Care (remote)

Cedars-Sinai•Los Angeles, CA

9d•$27 - $42•Remote

About The Position

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA). Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents. With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.

Requirements

Ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations.

Responsibilities

Conducts detailed audits for compliance with State, Federal and Health Plan regulatory requirements
Conducts pre and post payment audits on adjudicated claims in compliance with Cedar-Sinai policies, procedures and payment methodologies
Documents audit findings and presents errors to Claims Operations for corrections, root cause analysis and appropriate resolution
Provides analysis and prepares recommendations to Management for errors and inconsistencies
Provides process improvement suggestions to Management
Monitors appeals from providers, members and health plans to make sure they are processed accurately and in timely manner.
Monitors the daily auditing of processed claims and letters for accuracy.
Distributes and monitors multiple projects to make sure deadlines are met.