**Job Description** **Grow your career at Cedars-Sinai!** Cedars-Sinai Medical Center has been named to the Honor Roll in U.S. News & World Report’s “Best Hospitals 2024-2025” rankings . When you join our team, you’ll gain access to our groundbreaking biomedical research facilities and sophisticated medical education programs. We offer learning programs, tuition reimbursement and performance-improvement projects so you can achieve certifications and degrees while gaining the knowledge and experience needed to advance your career. We take pride in hiring the best, most hard-working employees. Our dedicated doctors, nurses and staff reflect the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for. **What will you be doing:** The Claims Auditor is responsible for ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations. + Conducts detailed audits for compliance with State, Federal and Health Plan regulatory requirements. + Conducts pre and post payment audits on adjudicated claims in compliance with Cedar-Sinai policies, procedures and payment methodologies. + Documents audit findings and presents errors to Claims Operations for corrections, root cause analysis and appropriate resolution. + Provides analysis and prepares recommendations to Management for errors and inconsistences. + Provides process improvement suggestions to Management. + Monitor appeals from providers, members and health plans to make sure they are processed accurately and in timely manner. + Monitors the daily auditing of processed claims and letters for accuracy. + Distributes and monitors multiple projects to make sure deadlines are met. **Qualifications** **Experience Requirements:** Four (4) plus years of professional and facility claims processing for Medicare and Commercial products. Must be familiar with provider dispute resolution. (preferred) Knowledge of claims processing, ICD-10, CPT-4 and HCPC, Excel, Word, and EPIC Tapestry along with CMS and DMHC regulations for compliance. **Education Requirements:** High School Diploma/GED. Bachelor’s degree in Healthcare or related field of study, preferred. **Req ID** : 7494 **Working Title** : Claims Auditor (Managed Care) **Department** : MNS Managed Care **Business Entity** : Cedars-Sinai Medical Center **Job Category** : Finance **Job Specialty** : Accounting **Overtime Status** : NONEXEMPT **Primary Shift** : Day **Shift Duration** : 8 hour **Base Pay** : $25.88 - $38.82 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.