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

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Job Description:

Job Summary: Responsible for processing all commercial and government payer requests for records related to DRG reimbursement audits and medical necessity reviews. Responsible for processing RAC (Recovery Audit Contractor) requests for medical record information. Processes other interdepartmental record requests, Quality audits and monitoring of fiscal task list. Responsibility includes receiving, logging and processing the initial request, as well as, any subsequent appeals. Update tracking logs on share drive providing the status of review for each account. Processing includes uploading records, photocopying records for paper based response and scanning/indexing documents for on-going reference. Consistent communication and status reporting to Director, Coding, and Coding Contractor will be essential. Off-cycle time will be spent on scanning and analysis support of discharged inpatient and observation records. Other Departmental support activities assigned as needed.

Essential Responsibilities:

Receives mailed/faxed requests from the RAC and other payers, tracks date of receipt.

For all requests: verifies patient identity, dates of service in Meditech. Pulls record, locates within EMR, and ensures all documentation is present and included in response.

Logs initial requesting on tracking excel sheet. Paying particular attention to due dates.

Pulls appropriate record/volume if applicable and adjusts record location with the chart tracking application. Locate requested information within Expanse EMR.

Photocopies or saves to CD, the requested medical record.

Responsible for upload of record copies via file transfer for various payers.

Distributes (usually by mailing) the photocopies and other required enclosures within the required timeframe as defined.

Receives / records all audit and RAC responses as accepted or denied, and records date of receipt.

Notifies Supervisor/Director (by e-mail) of RAC response on date of receipt. In cases of denial, includes auditing vendor in notification, and indicates due date for appeal.

Required Qualifications:

High School diploma or GED required. Associate's degree preferred.

1-3 years related work experience required in an administrative or office support role.

Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

Experience in medical office and/or hospital environment preferred.

Knowledge of medical terminology and coding preferred.

Knowledge of HIPAA and other Federal/State regulations, as well as, experience with Meditech preferred.

Competencies:

Decision Making: Ability to make decisions that are based on specific instructions, standard practices and established procedures which generally require little or no supervision.

Problem Solving: Ability to address problems that are routine, somewhat repetitive and generally solved by following clear directions and procedures and by identifying opportunities for process improvements.

Independence of Action: Ability to follow general instructions and procedures as provided. Work is monitored by supervisor/manager.

Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.

Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.

Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

Team Work: Ability to interact respectfully with other employees, professional staff and/or external contacts to offer ideas, identify issues, obtain information or deliver services.

Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Light work: Exerting up to 20 pounds of force frequently to move objects. Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move through out the hospital campus

FLSA Status:

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) and COVID-19 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