[Hiring] Release of Information Audit Abstractor @Mass General Brigham

Role Description

Under the direction of the Audit Supervisor and according to established policies and procedures, the individual is responsible for accurately abstracting protected health information (PHI) by sorting, categorizing, searching, retrieving, and sending encounter documentation to support the Mass General Brigham reimbursement and/or compliance audits for services rendered. The Audit Abstractor is responsible for:

• Responding to third party payer requests, appeals, denials, QIO, Mass Health, RAC, CMS, ADR, HEDIS, Medicare Risk Adjustment, CERT, CDAC, DPH reporting, DRG, charge audits, joint venture audits, internal compliance audits, DME, Patient Financial Services (PFS), OIG, and/or third party payer audits.
• Ensuring fulfillment of such requests on a timely basis to meet assigned due dates.

Qualifications

• Ability to prioritize competing tasks to ensure all due dates are met or exceeded.
• Accept ownership of assigned requests and worklists, reaching out for clarification if necessary.
• Understands and enforces hospital confidentiality policies and procedures, department policies and procedures including Massachusetts General Laws (MGL), Federal Public Health Laws, HITECH, and HIPAA regulatory guidelines.
• Reviews requests to determine completeness and validity of authorization.
• Maintains up-to-date knowledge of third party payer billing requirements to support services billed.
• Locates medical record numbers and dates of service for encounters to be reviewed in system applications.
• Produces computer-generated PHI from respective system applications.
• Coordinates electronic and paper record retrievals, troubleshooting for required records/documentation.
• Orders paper records as needed.
• Coordinates the retrieval of site-specific applicable joint venture records required for an audit.
• Effectively utilizes Cobius, secure delivery server, e-fax, Adobe, portals, legacy applications, archived systems, and scanning documents.
• Examines records to ensure required and complete documentation is available.
• Works independently and contributes as a productive member of a team.
• Notifies the HIM Notes Deficiency if required documentation is missing.
• Prepares and delivers records to the designated review/audit location in a timely manner.
• Ensures 100% of requested records are made available for an audit on time.
• Photocopies paper records and/or prepares PDFs for stat deliveries as needed.
• Prepares and coordinates the delivery of PHI via various methods to recipients as directed.
• Enters and fulfills all requests in logging system for tracking purposes.
• Meets performance measures/expectations.
• Other duties as assigned by the supervisor or manager.

Requirements

• Associate degree or High school diploma or equivalent required.
• Experience working in the Health Information Management field; minimum of 1-2 years experience preferred.
• Understands the components of a medical record, including how a record is maintained and organized.
• General understanding of reimbursement and billing compliance requirements.
• General knowledge of medical terminology.
• General knowledge of HIPAA privacy and security rules and state and federal rules and regulations related to the disclosure of protected health information preferred.
• Experience working with Epic clinical and/or financial applications preferred.

Skills/Abilities/Competencies

• Self-motivated and able to manage time effectively in a fast-paced work environment.
• Strong computer skills.
• Proficient utilization in Microsoft Office products (Outlook, Teams, Word, PowerPoint, and Excel).
• Exhibits critical thinking skills.
• Proficiency in the use of Adobe software.
• Ability to adapt to system enhancements and the onboarding of new site locations.
• Exhibits strong professionalism and highly proficient persona.
• Exhibits strong oral and written communication skills.
• Detail-oriented with excellent analytical and problem-solving skills.
• Ability to be flexible, versatile, and adaptable in day-to-day activities.
• Ability to manage workload and competing priorities to complete tasks within set limits.
• Ability to produce quality work on a consistent basis.
• Ability to work cooperatively and efficiently within all levels of the organization.
• Demonstrates commitment to delivery of high-quality customer service.
• Uses the Mass General Brigham values to govern decisions, actions, and behaviors.

Additional Job Details

• M-F 9:00am – 5:30pm EST schedule required for remote role.
• Quiet, secure, stable, compliant work station required.
• Remote Type: Remote.
• Work Location: 121 Innerbelt Road.
• Scheduled Weekly Hours: 40.
• Employee Type: Regular.
• Work Shift: Day (United States of America).
• Pay Range: $22.22 - $31.71/Hourly.
• Grade: 4.