Senior Application Auditor - FT - Days - MHS - Hybrid Eligible

Location:

Miramar, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary:

This position is responsible for designing, implementing, and modifying rules and requirements of Memorial Healthcare System's (MHS) applications to support organizational needs and compliance. Provides day‑to‑day management of assigned applications for complex or large applications; responsible for end‑to‑end application and systems configuration including the designing, developing, testing, debugging, installation, and training. This position serves as a lead role to provide Revenue Integrity services to our customers. The primary focus is ensuring accurate operation of applications via targeted audits, root cause analysis, and the development and implementation of system controls to prevent future errors. Additional focus will be keeping the Charge Description Master (CDM), Reimbursement, Charge Capture, and Billing applications up to date with monthly, quarterly, and yearly changes and communicate this to the users and department leaders.

Responsibilities:

Holds regular educational sessions for specialized coding requirements. Acts as a liaison for departmental inquiries regarding correct use of CPT and HCPCS codes for charges to increase coding accuracy ensuring optimal revenue. Utilizes feedback from HIM, Nurse Audit, and other clinical departments to build and implement application enhancements.Prepares documentation of system capabilities, output requirements, input data acquisition, programming techniques, and controls to maintain functionality and operability of the application.Ensures new software releases of the Epic system are set up correctly to prevent disruption or error in charge capture. Provides training and guidance to Epic Clinical Department teams to ensure proper use of CDM codes and work queue error resolution.Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping data capture accuracy. Serves as a subject matter resource in collaboration with HIM on CDM coding information. Audits and reviews all CPT, HCPCS, and revenue codes prior to EAP build. Builds custom Work Queues, Revenue Guardian tools, and Charge Router/Handler rules as needed to detect and prevent errorsMaintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation.Tests and troubleshoots existing and proposed systems to resolve and anticipate complex application issues. Designs and runs projects independently, meeting with department leaders and staff, and developing strategies to solve charging, documentation, and billing issues. Serves as a liaison between Revenue Integrity team and customers.Leads and oversees an entire business application module or system, providing mentorship and guidance to junior administrators to develop technical expertise. Review and recommend how mew technology may fit our IT strategy.Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization.Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department or third-party payors. Utilizes results of payor denials and edits to enhance pre-billing data capture and billing edits in Epic applications.Leads the planning of business application development and deployment, providing technical application expertise and building new functionality leveraging programming and clinical coding knowledge.Maintains data integrity when manipulating data files for purposes of analysis. Ensures data does not become corrupted in any way when performing analyses, through conscientious use of tools and a system of checks and balances. Spot-checks results of queries and reports to ensure meeting expectations before presenting finalized information. Runs data multiple ways when necessary to ensure accuracy of results.

Competencies:

ACCOUNTABILITY, ACCOUNTING - COST REPORTS, ACCURACY, ANALYSIS OF FINANCIALS, CUSTOMER SERVICE, HEALTHCARE REGULATORY ENVIRONMENT, MANAGING WORKLOADS, REGULATORY COMPLIANCE, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

Bachelors (Required)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judg