Cedars-Sinai Coding Auditor in Los Angeles, California
Under the general direction of the HID Audit Supervisor, the lead coding specialist shall: Monitor coding compliance through retrospective reviews or audits of ICD and CPT codes assigned by coding personnel. Monitor coding compliance by performing focused audits on high-risk areas identified by the Office of Inspector General (OIG) and the Centers of Medicare and Medicaid Services (CMS). Identify through focused audits operational and regulatory issues related to coding, documentation, and compliance. Identify and alert to trends found in reviews or data through Summary Reports. Provide education and training for coders and other healthcare professionals in both one on one and group settings. Comply with Federal, State, and CSMC Compliance Manual requirements to assist in improved data quality for reporting, research, and accurate billing and reimbursement of services rendered. Assist the HID Coding Department with coding of cases during shortage of staff. Perform additional activities (e.g. Data quality reports, etc.) as assigned. This particular position may also focus on research and resolution of claim edits identified through the core abstractions system (EPIC) as well as the claim scrubber system. If assigned, the position will require a high level of research capabilities to be able to facilitate appropriate resolution. Expert organizational skills to keep references in order. Experience in claim edits and/or denials management a plus.
Associate or Bachelor’s degree in Health Information Management or completion of courses in ICD-10-CM/PCS and CPT-4 coding from an accredited coding program or comparable level of education with 10 or more years coding experience in the acute care setting.
Certification in one of the following: Registered Health Information Technician (RHIT), Registered Health Information Associate (RHIA), Certified Professional Coder (CPC). or Certified Coding Specialist (CCS)
Minimum of 5 years of experience in the following: inpatient coding with the coding of various types of cases (e.g. medical and surgical) and outpatient coding with the coding of various types of cases (e.g. Emergency Room, Surgical/Ambulatory Care. Proficiency in ICD-10-CM/PCS and CPT-4 coding with excellent working knowledge of the DRG and APC payment methodologies, AHA Coding Clinic and CPT assistant. In addition, 3 or more years Coding Audit experience with auditing skills covering coding/billing accuracy, claims processing, denial management, and revenue cycle with a strong focus on Hospital outpatient revenue cycle including Hospital based Clinics.
Lifts, carries, moves and pushes equipment, books, paperwork and materials related to assigned work demanding ability to lift up to 30 pounds. Ability to sit for prolonged periods of time, use a computer keyboard for prolonged periods of time and look at a computer monitor for extended periods of time.
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.