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Cedars-Sinai Senior Physician Compliance Auditor - PBS Compliance in Los Angeles, California

The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or risks associated with documentation, coding and billing. Acts as a point of escalation for more sophisticated inquiries and issues. Will also work closely with senior leadership on discovered irregularities, needed action items, and makes recommendations to address areas of opportunity.

Job Duties and Responsibilities:

  • Requires high level experience in ANESTHESIA auditing, coding and compliance.

  • Performs physician compliance audits to ensure accurate coding and documentation practices are maintained.

  • Identifies areas of risk and/or non-compliance and provides recommendations for action - raises issues as needed.

  • Conducts education and training sessions with individual providers on results, regulatory requirements and provide useful feedback for improvement.

  • Tracks, records, and maintains audit/review activity.

  • Respond to sophisticated billing, coding, and documentation inquires.

  • Provides and ad hoc reporting.

  • Develops and revises education materials, conducts policy review, and ad hoc trainings.

  • Assists with risk analysis.

  • Assists in training, onboarding, mentoring new/less experienced team members.

  • Assists with audit & compliance related special projects as requested.

Education:

High school diploma/GED required.

License/Certification:

Current coding certification (CPC or CCS-P) required.

Experience:

This position requires expertise in ANESTHESIA coding, auditing, and compliance.

Five (5) years of proven experience reviewing chart documentation and coding/auditing physician professional services (preferably in a multi-specialty practice) required.

Three (3) years of experience with interpretation and communication of rules, regulations, and guidelines at expert level required.

One (1) year of experience coding charts for academic medical center required.

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.

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