Cedars-Sinai Coding/Appeals Analyst - PBS Compliance in Los Angeles, California
The Coding Analyst is responsible for analyzing and assessing governmental (RACs, Probes, CERT etc.) and nongovernmental reviews for trends. Will also validate improper payments, initiate claim appeal processes as appropriate, and conduct benchmarking comparison of CPT code (s) utilization. Collaborates with the Coding Education Specialist in identifying educational needs based on billing and documentation reviews and reports areas of trend and risks directly to the Manager of Physician Coding Education.
Job Duties and Responsibilities:
Reviews claim and medical record documentation to validate improper payments
Determines claim appeal process as appropriate
Supervises all published reviews by Noridian
Performs focused reviews and provides results to the team
Inputs all governmental reviews in AudaPro, including audit outcomes
Runs AudaPro reports to analyze trends, and utilizes results to recommend appropriate education and/or training
Ensures audit timelines for all audit types are followed accordingly
Communicates with providers to acquire documentation clarification
Performs charge corrections via CSLink billing system as appropriate
Researches coding issues that arise and reports areas of risk
Supervises Medicare rules for updates and changes
Assists in preparing audit reports as vital
Participates in meetings, training and conference calls as requested
Participates in workshops, seminars, audio conferences and other educational opportunities to ensure continued learning for self-improvement
High school diploma or GED required. Associates degree/college diploma preferred.
Certified Professional Coder required.
Three (3) years of coding experience in advanced professional multi-specialty group coding required.
Two (2) years of experience in chart reviews required. Governmental reviews preferred.
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.