Manager ROI Audit Research

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

Manages all functions of the ROI/Audit and Research Department. Utilize technology to support ongoing efforts to protect patient privacy, security and integrity of patient information. Manage audits. Oversee appeal of denials. Oversee ROI operations, high volume call center and information request processing. Manage assigned staff.

Job Description:

Essential Duties & Responsibilities:Supervisory Functions

• Manage all functions of the ROI/Audit & Research Department: Front desk services, release of information, customer service; investigate and follow up on patient privacy and security concerns, process amendment requests, collaborate with Customer Relationship Management, Legal, and Risk when necessary to resolve issues; provide training and education to colleagues; work with management to implement new technology and processes to improve services and gain efficiencies.
• Orient, train, supervise, schedule, and assign work within the ROI/Audit & Research area. Recommend and/or approve personnel actions, including but not limited to hiring, transferring, suspending, discharging, assigning, disciplining, or adjusting grievances involving colleagues; interview and select, with the manager, candidates for employment.
• Proactively develop plans to meet future departmental/Beth Israel Lahey Health (BILH) needs utilizing technology and metrics to assess, plan, and implement new systems as well as technology and consolidation of services when applicable.
• Utilize technology to support ongoing efforts to protect patient privacy, security, and integrity of patient information and utilize tools provided: Record Management System (RMS), Breach tracking and reporting
• Monitor, track, and investigate potential or alleged privacy breaches; provide enterprise-wide support for privacy and security initiatives that impact the organization and its stakeholders.
• Manages third-party DRG audits of all 2nd party payors, DRG, Medical Necessity, ADRs, and HEDIS. Assures record availability, and discusses issues with outside auditors and the inpatient coding manager/CDI. Prepares appeals on appropriate cases to ensure proper reimbursement. Analyzes and reports findings to Patient Financial Services (P.F.S.) management and appropriate departments. Utilize an audit tracking system (Cobius) to monitor audit processes, dollars at risk, and appeals. Provide support and training to colleagues.
• Medicare Fraud and Abuse Unit, the Medicare Program Integrity Unit, and the Office of Inspector General for the Department of Health and Human Services. Responds with appropriate information to limit legal liability and coordinate compliance issues with P.F.S. management.
• Oversees appeal of denials received from fiscal intermediaries. Works with management from P.F.S., internal audit, Case Management, Coding/CDI, and any other clinical and administrative departments to resolve billing and documentation errors and denials. Reports issues to compliance and other appropriate areas when necessary.
• Understand applicable Human Resources and Department Policies work within the confines of said policies and · handle grievances appropriately.
• Listen to and respond to employee problems in a timely manner and act as their advocate if indicated.
• Provides/prepares reports to Administration, providers, clinic managers, and others for program analysis, grants, marketing, planning, and accreditation purposes.
• Maintains colleagues’ timecards, attendance records, and vacation schedules and prepares overtime reports when necessary.
• Review and make recommendations to policies and procedures, job descriptions, and conduct performance appraisals annually.
• Attends department meetings, and interacts with managers, supervisors, and other leaders to coordinate departmental activities and problem resolution.
• Conducts regularly scheduled department meetings.
• Patient centered customer service – Oversee front desk operations, high volume call center and information request processing; provide and support education and training of colleagues on new technologies, equipment, systems and services. Work closely with Customer Relationship management to assist patients with information needs; amendments, privacy/security concerns, patient portal access, continuing care needs.
• Manage and coordinate services involving investigation and resolution of alleged data breaches; amendment requests; patient privacy and security concerns; third-party compliance audits, record reviews, and requests for patient information. Work collaboratively with Legal, Risk, and Compliance to provide ongoing support and resources throughout BILH to manage and mitigate risk
• Work collaboratively with HIM management and other departments to improve processes and resolve issues; provide education and support to BILH departments/clinics regarding information management, patient care, privacy and security, and regulatory compliance.
   

Judgment Initiatives
* Participate in the development, implementation, and evaluation of processes that support the HIM department and BILH goals and mission* Monitor and assess services that support operational functions of the HIM Department* Communicate effectively with colleagues, peers, other departments, and management to keep them informed of changes in policies and procedures* Provide support, education, and training to all colleagues in regard to privacy, security, and data integrity as it relates to release of information and patients’ rights* Maintains knowledge base of HIPAA, privacy, security, JC requirements, Federal and statutory laws, and any changes and/or updates to policies and procedures that affect management of health information
* Works with manager to develop tools to monitor quality and productivity, makes recommendations to improve services, reduce errors (HRO), improve workflowRound regularly with colleagues, listen to ideas, implement changes when able, participate in colleague engagement initiatives, comply with BILH guiding principles, and lead by example.Minimum Qualifications:Education: Bachelor’s degree with credentialing as a Registered Health Information Administrator, or Associate’s credentialing as a Registered Health Information Technologist or Associate degree with equivalent management experience.Experience: Five (5) to seven (7) years of supervisory experience in healthcareSkills, Knowledge & Abilities: Excellent written and oral communication skills. Prior experience using EHR software.

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