Sr. Clinical Audit Specialist
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 62400 - 90750
Posted on:
01-11-2025
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Reporting to the Central Audit Manager the Senior Clinical Audit Specialist must have an understanding of medical terminology coding charge entry and revenue cycle processes. The Senior Clinical Audit Specialist provides support for accurate timely and inclusive charge capture coding assignments billing functions and revenue routing through evaluation and interpretation of payer updates performance of record audits presentation of staff education and other related activities. The Senior Clinical Audit Specialist performs audits and identifies operational financial compliance and other findings in order to make appropriate conclusions and determine next steps best practices and needed communications. This individual works collaboratively with the clinical audit team to identify charge system (including clinical system) weaknesses recommends changes provides education and tracks utilization. This position is integral to the Central Audit team to assist in ensuring patient services are accurately charged appropriately coded supported by clinical documentation and that the related revenue is recorded in the proper department. The SeniorClinical Audit Specialist must approach problem-solving challenges independently under limited supervision from the Central Audit Manager or other more senior team members have a strong attention to detail and enjoy working in a fast-paced collaborative team-based environment. The RI team is responsible for department charge audits and data analytics as well as investigating and resolving charging and coding issues and staying abreast of all changes related to billing/coding compliance. The Senior Clinical Audit Specialist coordinates processes between clinical operations and revenue cycle departments ensuring that the accounts audited reflect proper documentation charge capture coding and billing to support proper payment. The Senior Clinical Audit Specialist also confirms that the charges are routed to the appropriate department/cost center. Audits will be assigned for encounters falling within the IP OP and ED areas for both hospital and professional services with the expectation that this person understands hospitals payer contracts and reimbursement methodologies. This person will assist the RI team with running revenue reports daily and will explore possibilities of revenue leakage in any targeted areas identified through the audit process.
Qualifications
Bachelors Degree in Health Information required or Bachelors Degree Related Field of Study
Licenses and Credentials
Applicable professional certification through AHIMA (RHIA RHIT CCA) or AAPC (CPC-A CPC COC-A COC) or other coding certification required.
Experience
Healthcare auditing or financial auditing experience 3-5 years required
Principal Duties and Responsibilities
- Perform audits meet with departmental leadership to review findings documentation standards and recommendations for improvement. Targeted populations are identified through random
sampling focused quarterly reviews issues identified in collaboration with various MGB personnel and rotation/selection of specific clinical areas.
- Audits include review of selected medical records documentation to determine accuracy of coding assignments billing compliance medical necessity and when appropriate collaborate with hospital HIM and revenue cycle departments to identify physician and clinic practices that require improved documentation.
- Analyzes charge capture audit reports to verify that appropriate charges have been posted to patient accounts according to diagnosis and related procedure codes and that revenue has been routed/recorded in the appropriate department/cost center.
- Performs ancillary service quality assurance reviews and departmental audits and meets with the department managers and staff to instruct and inform on documentation findings to increase accuracy; recommends solutions to improve charge capture accuracy.
- Provides feedback to providers regarding missing incomplete unspecific unclear or conflicting documentation.
- Provides coding documentation and compliance guidance as requested.
- Assists and directly provides training in group settings as well as one-on-one.
- Presents in-services to nursing physician and clerical personnel regarding processes updates and reviews relating to audit findings and/or regulatory compliance.
- Coordinates with Clinical Nurse Auditor(s) Clinical Audit Specialist(s) or RI Analyst(s) to complete various inquiries by departments to ensure accurate and timely responses.
- Maintains current knowledge of the Charge Description Master clinical charging procedures and related systems for the production of a bill/claim.
- Remains current with regulation changes and related operational processes by attending coding conferences workshops and in-house sessions for updated coding information.
- Actively participates in team development achieving dashboards and in accomplishing department goals and objectives.
- Participates in MGB internal projects
- Other duties as assigned
Knowledge Skills and Abilities
- Strong oral and written communication skills.
- Strong problem-solving and critical thinking skills required.
- Strong organizational and time management skills.
- Strong character credibility ethics and integrity.
- Strong knowledge of clinical care processes and documentation.
- Ability to manage large project assignments.
- Ability to investigate analyze and resolve issues
- Ability to interact and garner trust with various levels of staff in the organization by providing practical sound accurate and timely support.
- Ability to review and interpret clinical data to determine whether the services are supported by the documentation.
- Ability to work independently in a role that requires flexibility in an environment that is deadline-driven with minimal direction from leadership.
- The ability to research applicable CMS regulations MGB charging policies and payer medical and reimbursement policies
- Experience with computer software programs such as Microsoft Office Suite (PPT Word Excel etc.) and Epic.
Additional Job Details (if applicable)
M-F 8:00 AM -4:30 PM Eastern Business hours required for remote role
Quiet secure stable compliant work station required
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$62400.00 - $90750.40/AnnualGrade
6EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Senior IC
Key Skills
- Auditing
- Microsoft Office
- Communication skills
- Computer Skills
- GAAP
- Accounting
- Analysis Skills
- Research Experience
- Securities Law
- Training & Development
- Mentoring
- GAAS
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
