Release of Information Audit Abstractor, Healthcare

About the role

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.

Responsibilities

• Responds 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.
• Fulfills such requests on a timely basis ensuring that assigned due dates are met.
• Reviews requests to determine completeness and validity of authorization.
• 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.
• Able to redact information when necessary.
• 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.
• Notifies the HIM Notes Deficiency if required documentation is missing for assistance.
• 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.

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.
• 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.
• 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.
• Notifies the HIM Notes Deficiency if required documentation is missing for assistance.
• 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.

Skills

• 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.
• Works cooperatively and efficiently within all levels of the Mass General Brigham organization.
• Works 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.

Additional Job Details

• M-F Eastern Business hours required for remote role.
• Quiet, secure, stable, compliant work station required.
• Remote Type: Remote.
• Scheduled Weekly Hours: 40.
• Employee Type: Regular.
• Work Shift: Day (United States of America).
• Pay Range: $22.22 - $31.71/Hourly.
• Grade: 4.