Healthcare, Release of Information Audit Abstractor

Site: Mass General Brigham Incorporated 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. 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 - 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