Business Configuration Auditor Senior
CHRISTUS System Office
CHRISTUS Corp Irving Offices 919 and 909 Buildings
919 Hidden Ridge
Irving, TX 75038
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Under the supervision of the Manager of Network Services, this position is responsible for oversight of auditing configuration of Provider Data information and assessments related to all of the Provider Data configuration areas. This person is responsible for assisting in the more complex technical and analytical work related to validation and quality assurance of business requirements for the configuration of the CHRISTUS Health plans. Establishing structure and standardization, creating and updating of departmental policies, process, implementation, maintenance and oversight of auditing configuration. Additional functions of this role are managing overall task assignment inventory and quality, resolving escalated system issues and assisting with policy, regulatory or contractual questions and concerns. The auditor collaborates closely with peers and management within the department as well as throughout the organization to ensure that the most complex data sets are analyzed and the well thought-out recommendations for improvements are presented and implemented, where warranted.
- Oversight of and coordination of core-system Provider Data configuration audits, including: Fee Schedules, Contracts, Provider Demographics, Member PCP moves, Claims defect resolutions for Auto-Adjudication, Provider Picking logic, Perfect Claim setting selection, Explanations, Transforms, UniFlow Workflows, Reference Codes, Custom Attributes, and all related provider data configuration.
- Developing and executing Audits to find gaps in software, configuration, policies, procedures, and processes
- Cataloging internal audit results and communication findings, including recommendations, to appropriate leadership
- Developing metrics and reporting key risk indicators and completes appropriate documentation for tracking/trending data
- Maintaining thorough and concise documentation for tracking of all provider data configuration change request forms for quality audit purposes.
- Assisting with developing and maintaining departmental goals and objectives
- Producing weekly, monthly, quarterly and annual management and operations focus reports in a timely manner
- Assisting in the development of action plans to address system deficiencies
- Monitoring and tracking best practices and merging compliance changes/impacts for continuous improvement opportunities
- Developing processes to analyze, design, configure and QA detailed benefit designs
- Identify prevalent trends through data reporting
- Ownership of Provider Data Configuration Auditor tasks assignment
- Performs other related duties and special projects as requested by management
- Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
- Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
- Bachelor’s degree or equivalent experience in Healthcare claims adjudication, Provider Data management and auditing
- Ability to organize and prioritize work to meet deadlines
- Strong computer application skills including Microsoft Word, Excel, Visio, SQL
- Excellent written and verbal communication skills required
- Good judgment, initiative and problem solving abilities
- Ability to handle and resolve complex issues independently
- Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
- Knowledge of CPT/HCPCS, ICD-9, ICD-10 coding and medical terminology.
- Ability to learn new policies and processes based on written material and observation
- Ability to establish and maintain professional, positive and effective work relationship
- Healthcare experience with Managed Care experience preferred
- Provider experience preferred
- 2 years’ experience with configuration audit and Provider Data management
- Prior experience working with TRICARE, Texas Medicaid, Medicare Advantage highly desirable.