Lead Coding Auditor Details

Lead Coding Auditor

CEDARS-SINAI - Los Angeles, CA

Employment Type : Full-Time

Grow your career at Cedars-Sinai!

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai has received the National Research Corporation’s Consumer Choice Award 19-years in a row for providing the highest-quality medical care in Los Angeles. Join us and discover why U.S. News & World Report has named us one of America’s Best Hospitals!

Why work here?

Beyond an outstanding benefit package and competitive salaries, we take pride in hiring the best, most committed employees. Our staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a multifaceted, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

What will you be doing:

The Lead Coding Specialist will Supervise coding compliance through retrospective reviews or audits of ICD and/or CPT codes assigned by coding personnel. Perform 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.

• This 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 standard of research capabilities to be able to facilitate appropriate resolution.
• Performs quality coding reviews or audits per ICD-10-CM Coding Guidelines and coding guidelines published in AHA in Coding Clinic.
• Meets established departmental efficiency and accuracy standards. Performs coding queries when vital for diagnosis and documentation clarification.
• Assists with processing re-bills post coding audit changes and assists with coding corrections needed from PFS.
• Maintains appropriate communication with supervisor and coding manager regarding audit findings and other significant issues or patterns observed.

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Experience Requirements:

• Five (5) + years’ experience with Inpatient coding (e.g. medical and surgical) and Outpatient (Ambulatory) coding in the coding of different types (e.g. Emergency Room, Surgical/Ambulatory Care).
• Proficiency in ICD-10-CM and CPT4 coding with solid understanding of the DRG and APC payment methodologies, AHA Coding Clinic and CPT assistant.
• Three (3) + years’ experience in Coding Audit experience with auditing skills covering coding/billing accuracy of coding staff.

Education/Certificate Requirements:

High School Diploma/GED required.

Associate and/or Bachelor’s Degree in Health Information Science, Completion of courses in ICD-10-CM or CPT-4 coding from an accredited coding program, or Comparable level of education with 10+ years coding experience in the inpatient setting.

Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) required.

Certified Coding Specialist (CCS-P), Certified Procedural Coder (CPC), Certified Outpatient Coder (COC), and/or Registered Health Information Administrator (RHIA). (preferred)