Health Information Management Audit Specialist

When you join the growing BILH team, you’re not just taking a job, you’re making a difference in people’s lives.

Under the direction of the Director of Health Information Management, the Health Information Management Audit Specialist handles various audit requests for the release of confidential patient medical information, coordinates the completeness of the documentation with the record requested, and performs a complete documentation review. They coordinate all the logging and tracking of requests and the audit process from initiation through mailing, in collaboration with other hospital departments. Organizes the follow-up appeals documentation post-audit and coordinates the submission of the Physician Attestation Statements for Signature verification audits. Assists requestors with access to confidential patient information in accordance with state, federal, and regulatory requirements governing the privacy of the patient information, assures confidentiality standards are met, provides accurate and timely medical records services, and ensures customer/patient satisfaction for the Health Information Management (HIM) Department.

Job Description:

Essential Duties & Responsibilities including but not limited to:

• Responds to telephone, in person, faxed and mailed requests for patient medical record information from a variety of sources (e.g. Auditors, CMS, BCBS, Permedion, DPH, Nurse Audit, HCHP, DPH, Disability, Workman’s Comp, EHR, attorneys, patients, insurance agencies, social services, subpoenas/court orders) and verifies the legitimacy of the authorizations, as well as sensitive authorizations, to meet state, federal and regulatory requirements governing the release of the confidential patient information.
• Coordinates with any contractual release of information services/agencies that provide the photocopying & scanning of the medical records on behalf of the hospital to ensure accuracy and timeliness of the processing.
• Applies all HIPAA privacy rules & legal statutes to handling requests for confidential patient medical information and uses special handling rules for sensitive medical information that is further protected under state & federal laws (e.g., Drug & Alcohol Information, HIV/AIDS, genetic testing). In the case of “privileged information”, the request is handled specifically to meet the requirements of a court-ordered privileged release according to Massachusetts statute. Directs any issues or concerns to the HIM Director.
• Reviews each Audit request for specificity in the documentation requested (e.g., MAC, RAC, Payor Audits, Compliance Audits) and verifies that the documentation is either completed or requests that the Physician comply (e.g., completing required forms or actual documentation within the records).
• Works closely with Medical Staff, Physician Office Managers, Medical Staff Office, Patient Accounts, Case Management, Physical Therapy, and the Lab for specific documentation required by outside payor auditors. Locates the required documentation for a complete submission meeting the federal requirements for the specific audit.
• Coordinates all the documentation reviews, completeness, photocopying/scanning, final review, and submission to Permedion and EHR for appeals on behalf of Case Management. Works closely with Case Management to ensure that everything is tracked and logged for future reference.
• Handles the logging, tracking, and quality control/reviews of all post-payment audit appeals, as provided by the Director of Health Information Management and the Manager of Coding, to ensure timely and complete submission of required documentation to support the appeal process.
• Ensures that all patient medical information is complete and signed by the Physician/Clinician responsible for the patient’s care prior to any release, identifies any documents needing completion & refers them to the physician delinquency staff, and verifies that the documentation meets the conditions approved for the release.
• Coordinates the needs for records in offsite storage with file room personnel, copies of bills with Patient Accounts, films with Radiology, and other ancillary requests with the appropriate hospital Department in order to comply with the request according to established HIM Department policy and procedures.
• Maintains the confidentiality of the patient while verifying the requestor identity and a “need to know” prior to allowing release, auditing, review, or access to patient medical information. Upholds all privacy principles to prevent medical identity theft or inappropriate access.
• Secures the confidentiality of the patient records and information while performing the job responsibilities of this position (e.g., correspondence window area) and maintains secure access into the department during business hours (e.g., proxy card access).
• Maintains health record tracking system for all records and medical record information requested, distributed from, and received by the HIM Department
• Maintains an accurate and concise medical record tracking system within the EPIC computer system and the IatriTRAC System (for specific post-payment audits) for all records and medical record information requested, distributed from, and received by the HIM Department for auditing, tracking, and compliance purposes.
• Adheres to the HIM Department, Beth Israel Lahey Health (BILH), and hospital-wide quality assurance standards
• Fosters respect for patient privacy and confidentiality by maintaining and upholding the highest level of confidentiality in all phases of the work.
• Follows hospital and department policies and procedures to contribute to the safety, efficiency, and effectiveness of the Health Information Management Department and hospitals.

Minimum Qualifications:

Education: High School education or GED

Licensure, Certification & Registration: N/A

Experience: Minimum one (1) year acute care hospital Health Information Management experience preferred.

Skills, Knowledge & Abilities:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Reasonable accommodations may be made to enable the individual to perform the essential functions.
• Must possess verbal and written skills to communicate effectively and courteously with a diverse group of professional and non-professional member

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients’ lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

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