ROI Medical Record Abstractor - Audit

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POST DATE 8/20/2016
END DATE 10/27/2016

Partners HealthCare(PHS) Somerville, MA

Company
Partners HealthCare(PHS)
Job Classification
Full Time
Company Ref #
3023545
AJE Ref #
575940204
Location
Somerville, MA
Experience
Entry Level (0 - 2 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

APPLY
ABOUT US

As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Womens Hospital and Massachusetts General Hospital, Partners HealthCare 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.

Were focused on a people-first culture for our systems patients and our professional family. Thats why we provide our employees with more ways to achieve their potential. Partners HealthCare 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 developmentand we recognize success at every step.

Our employees use the Partners HealthCare 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.

GENERAL OVERVIEW

Under the general supervision of the HIM Supervisor, Release of Information (ROI) and Audit , and according to established policies and procedures, this position is responsible for accurately abstracting protected health information (PHI) by sorting, categorizing, searching, retrieving and sending encounter documentation to support the Partners reimbursement and compliance process for services rendered.

The Audit Record 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, Central Billing Office (CBO) requests, OIG, and/or third party payer audits including off-site and on-site reviews. Fulfillment of such requests are performed on a timely basis ensuring that assigned due dates are meet.

JOB DESCRIPTION

Understands and enforces hospital confidentiality policies and procedures, ROI 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, PHS policies and procedures. Knows how 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, released and/or audited.
Produces computer-generated PHI from legacy and/or PeC applications.
Coordinates electronic and paper record retrievals, trouble shoots for required records/documentation for in response to a request/audit.
Orders records from the off-site location at the warehouse.
Coordinates the retrieval of site specific applicable joint venture records required for audit.
Effectively utilizes CAS, Cobius, Cobius-esMD (including posting pdfs, merging and sending pdfs via esMD), LMR, Huron, Xclaim, MUSE, secure delivery server, fax server, Adobe (searching, redacting and securing security settings), archiving system, scanning documents, merging files, etc.
Acquires and maintains a strong working knowledge of the secure delivery server and fax server functionality. Able to troubleshoot issues as needed.
Examines records to be released and/or audited to ensure required and complete documentation is available for review on the due date.
Schedules on-site audit appointments based on appropriate staffing and secures available space to conduct the audit as needed.
Works independently, as well as, contribute as a productive member of a team.
Coordinates the electronic submission of PHI to ensure due dates are met. Submissions may include via a fax server, secure delivery server, and/or Cobius-esMD.
Notifies the appropriate HIS unit if required documentation is missing for assistance. Troubleshooting may include 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 are available for review on time or provides expeditious follow up if needed.
Photocopies paper records or prepares pdfs for stat deliveries as needed.
Prepares and coordinates the delivery of PHI via FedEx/UPS/US Mail or via the secure delivery server electronically to recipient as directed for offsite audits.
Enters and fulfills all requests in the PeC application for tracking purposes.
Meets productivity as required by the workflow.
Other duties assigned by the supervisor or manager.
Uses the Partners HealthCare 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

High school diploma or equivalent required.
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. Knowledge of 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, and Competencies Required
Self-motivated and able to manage time in a busy office environment with interruptions.
Critical thinking skills and sound reasoning abilities.
Strong customer service and proficient verbal, written and telephone communication skills. Must be courteous and cooperative at all times when interacting with auditors and all levels of departmental and hospital personnel.
Must utilize medical terminology and clinical knowledge to support problem-solving issues. Detailed oriented skills required.
Basic computer skills. Competent in Adobe, Outlook, Word and Excel tools and other related computer applications.
Prioritizes tasks in a dynamic work environment with multiple and conflicting demands, successfully performs different tasks simultaneously.
Establishes and maintains cooperative working relationships with co-workers, outsourced vendors and customers.
Stands, bends, and/or push/pulls record carts and lift/carry paper medical records.

WORKING CONDITIONS
Fast paced working environment.
Work with others in a close work space environment with noise from office equipment.
May involve lifting and carrying paper medical records as needed.
Work setting may include designated work space in an office setting and/or a remote location.

SUPERVISORY RESPONSIBILITY
None.

FISCAL RESPONSIBILITY
Not Applicable.

Partners HealthCare is an Equal