Cedars-Sinai

Claims Auditor, Managed Care (remote)

Cedars-Sinai • $70K — $95K *
Los Angeles, CA 90011In-Person
Healthcare
Less than 5 years of experience
4 days ago
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • High School Diploma/GED required; Bachelor's Degree in healthcare or related field preferred.
  • 4 years of experience in professional and facility claims processing for Medicare and Commercial products.
  • Familiarity with provider dispute resolution is preferred.
  • 5 years of Senior/Lead or Claims Audit experience in a medical claim setting preferred.
  • Strong understanding of compliance with State, Federal, and Health Plan regulations.

Responsibilities

  • Conduct detailed audits for compliance with State, Federal, and Health Plan requirements.
  • Perform pre and post payment audits on adjudicated claims according to policies and payment methodologies.
  • Document audit findings and present errors to Claims Operations for corrective actions.
  • Analyze and prepare recommendations to Management for identified errors and inconsistencies.
  • Suggest process improvements to Management.
  • Monitor appeals from providers, members, and health plans for accurate and timely processing.
  • Oversee daily audits of processed claims and letters for accuracy.

Benefits

  • Comprehensive health insurance options.
  • Generous paid time off policy.
  • Opportunities for professional development and training.
  • Collaborative work environment with a focus on process improvement.
  • Flexible work hours to support work-life balance.
Full Job Description
Job Description

The Claims Auditor is responsible for ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations.
Primary Duties and 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 inconsistences
  • 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.


Qualifications

Job qualifications
Education
  • High School Diploma/GED required
  • Bachelor's Degree healthcare or related field preferred
Work Experience
  • 4 years of professional and facility claims processing for Medicare and Commercial products. Must be familiar with provider dispute resolution preferred
  • 5 years of Senior/Lead or Claim Audit experience in a medical claim setting preferred


About Cedars-Sinai

Cedars-Sinai is a non-profit academic medical center located in Los Angeles, California. It is one of the largest hospitals in the United States, with over 1,000 beds and 2,000 physicians. Cedars-Sinai is known for its high-quality patient care, cutting-edge research, and innovative medical education programs. The hospital has been ranked as one of the best in the country by U.S. News & World Report, and has received numerous awards and accolades for its clinical excellence and research achievements. Cedars-Sinai is affiliated with the David Geffen School of Medicine at UCLA and is a member of the Cedars-Sinai Health System.
Learn more about Cedars-Sinai
Size
13,000 employees
Industry
Healthcare
Founded
1902
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at Cedars-Sinai

More Healthcare Jobs

Find similar Claims Auditor, Managed Care (remote) jobs:

NationwideLos Angeles, CA