Healthcare, Release of Information Audit Abstractor

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 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

Education

Associate degree or High school diploma or equivalent required

Experience

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
• 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
• 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