Release of Information Audit Abstractor

Mass General Brigham

8d•$22 - $31•Remote

About The Position

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary 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, including but not limited to, 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. Fulfillment of such requests are performed on a timely basis ensuring that assigned due dates are met.

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, organized and the retrieval of medical documentation in both paper and/or electronic format
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
Self motivated and able to manage time effectively in a fast paced work environment
Medical Terminology
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
Excellent analytical and problem solving skills
Ability to be flexible, versatile, and adaptable in day to day activities conducted in a multi-site environment
Ability to manage workload and competing priorities in order 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 Mass General Brigham organization
Ability to work independently and as a team player
Demonstrates commitment to delivery of high quality customer service
Uses the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability and Service Commitment, Decisiveness, Innovation and Thoughtful Risk; and how we treat each other: Diversity and Inclusion, Integrity and Respect, Learning, Continuous Improvement and Personal Growth, Teamwork and Collaboration

Nice To Haves

Experience working with Epic clinical and/or financial applications preferred

Responsibilities

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. Understands the rules governing the release of sensitive/protected PHI as pertaining to HIPAA, CFR 42 Part 2 rules, MA public health laws, MA mental health laws regulations, as well as, Mass General Brigham policies and procedures. Able to redact information when necessary.
Maintains up-to-date knowledge of third party payer billing requirements to support services billed, including required medical documentation based on billing compliance rules
Locates medical record numbers and dates of service for encounters to be reviewed in system applications in response to requests
Produces computer-generated PHI from respective system applications including legacy applications
Coordinates electronic and paper record retrievals, trouble shoots for required records/documentation in response to a request and/or audit
Orders paper records as needed
Coordinates the retrieval of site specific applicable joint venture records required for an audit
Effectively utilizes Cobius, (emDR and esMD, including accessing requests, posting pdf’s, merging and delivering pdf’s), secure delivery server, e-fax, Adobe (searching, redacting, merging files, and securing security settings), portals, legacy applications, archived systems, and scanning documents. Acquires and maintains a strong working knowledge of the secure delivery server and e-fax functionality. Able to troubleshoot issues as needed.
Examines records to be released and/or audited to ensure required and complete documentation is available to meet the requirements of a request
Works independently, as well as, contributes as a productive member of a team
Notifies the HIM Notes Deficiency if required documentation is missing for assistance. Troubleshooting may also require contacting appropriate providers/clinics to obtain required documentation.
Prepares and delivers records to the designated review/audit location in a timely manner for onsite audits
Ensures 100% of requested records made available for an audit on time or provides expeditious mitigation to reconcile as needed
Photocopies paper records and/or prepares PDF’s for stat deliveries as needed
Prepares and coordinates the delivery of PHI via FedEx/UPS/US Mail, Cobius esMD, portal, e-fax, or secure delivery server to recipient as directed for offsite audits
Enters and fulfills all requests in logging system for tracking purposes
Meets performance measures/expectations
Other duties as assigned by the supervisor or manager