Facility Inpatient Surgical and Claims Edit Auditor

Cedars-Sinai Medical Center is hiring a Facility Inpatient Surgical and Claims Edit Auditor to work under the general direction of the Coding Supervisor. This role is for a coding professional who reviews encounters in either a prebill or retrospective workflow to validate a coding profile. The auditor checks applicable code sets to encounter type, abstracted data elements, missed query opportunities, and other related encounter data collection points.

The position evaluates compliance with all coding guidelines, including Internal Coding policies, procedures, and handbook; American Hospital Association (AHA) and American Medical Association (AMA) coding references; and local, state, and federal coding guidelines.

What you will do

• Perform quality coding reviews or audits within established departmental productivity and accuracy standards.
• Assist with processing re-bills after coding audit changes and with coding corrections needed from the billing department.
• Provide written summary reports of findings.
• Coordinate and lead 1:1 or small group feedback sessions based on recommendations.
• Maintain open communication with internal and external partners and peer departments such as Coding Operations, Clinical Documentation Integrity (CDI), Payor Revenue Management (PRM), and Compliance Revenue Integrity (CRI).
• Assist peer departments with production coding of cases during staff shortages.
• Help improve data quality for reporting and research, accurate billing and reimbursement of services rendered, which overall improves the quality of care for the patient.
• Provide 1:1 and small group education sessions, facilitate round table discussions, contribute content to the coding newsletter, and provide basic level trending or data review for opportunities.
• Evaluate codes through data reports and trended opportunities, audit to validate findings, and produce summary reports with recommendations of action plans.
• Perform additional activities (e.g., data quality reports) as assigned by the Coding Supervisor.

What they are looking for

The source text does not list specific education, certification, or years of experience. The role requires the ability to review encounters in prebill or retrospective workflows, validate coding profiles, and apply coding guidelines from internal policies, AHA and AMA references, and local, state, and federal rules. You will need to produce written reports, lead feedback and education sessions, and work with peer departments.

About Cedars-Sinai

Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. The organization also received the Advisory Board Company’s Workplace of the Year, an annual award that recognizes hospitals and health systems nationwide with outstanding levels of employee engagement. U.S. News & World Report has named Cedars-Sinai one of America’s Best Hospitals.

Benefits

Cedars-Sinai provides a benefit package that includes health care, paid time off, and a 403(B).

Location

This role is based in the United States.