As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

The Opportunity

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.

Principal Duties and 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

Skills For Success

• 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

• This position requires occasional local travel to Mass General Brigham site locations, and/or conferences
  
  • Hospital work environment working conditions include possible exposure to diseases or infections and may require safety gear (PPE) such as gloves and mask
  • Normal office working conditions. The noise level in the work environment is quiet to moderate.
  • While performing the duties of this job, the employee is frequently required to sit; talk; or hear; use hands to finger; handle; or feel; reach with hands and arms. The employee is occasionally required to stand; walk; and stoop; kneel; or crouch. The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 20 pounds.
  • Specific vision abilities required by this job include close vision, distance vision and depth perception
  • Remote work environment requires utilization of Mass General Brigham equipment and requires “on-camera” participation
  • Hybrid schedule may be utilized to meet business needs

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.