Release of Information Audit Abstractor

Mass General Brigham

112d • $21 - $31

About The Position

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.
• Understand 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.
• Experience working with Epic clinical and/or financial applications preferred.

Nice To Haves

• 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.
• 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.

Responsibilities

• 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.
• Understand and enforce hospital confidentiality policies and procedures, department policies and procedures including Massachusetts General Laws (MGL), Federal Public Health Laws, HITECH, and HIPAA regulatory guidelines.
• Review requests to determine completeness and validity of authorization.
• Understand 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.
• Redact information when necessary.
• Maintain up-to-date knowledge of third party payer billing requirements to support services billed, including required medical documentation based on billing compliance rules.
• Locate medical record numbers and dates of service for encounters to be reviewed in system applications in response to requests.
• Produce computer-generated PHI from respective system applications including legacy applications.
• Coordinate electronic and paper record retrievals, troubleshoot for required records/documentation in response to a request and/or audit.
• Order paper records as needed.
• Coordinate the retrieval of site specific applicable joint venture records required for an audit.
• Effectively utilize 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.
• Acquire and maintain a strong working knowledge of the secure delivery server and e-fax functionality.
• Examine records to be released and/or audited to ensure required and complete documentation is available to meet the requirements of a request.
• Work independently, as well as, contribute as a productive member of a team.
• Notify the HIM Notes Deficiency if required documentation is missing for assistance.
• Prepare and deliver records to the designated review/audit location in a timely manner for onsite audits.
• Ensure 100% of requested records made available for an audit on time or provide expeditious mitigation to reconcile as needed.
• Photocopy paper records and/or prepare PDF’s for stat deliveries as needed.
• Prepare and coordinate 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.
• Enter and fulfill all requests in logging system for tracking purposes.
• Meet performance measures/expectations.
• Perform other duties as assigned by the supervisor or manager.

Benefits

• Competitive base pay.
• Comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums and bonuses as applicable.
• Recognition programs designed to celebrate your contributions and support your professional growth.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees