Payer Audit Technician

New Haven, CT
Mar 12, 2019


Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.


The HIM Audit Technician performs a variety of duties to support the timely, accurate and compliant fulfillment of audit requests that includes patient medical information. Primary responsibilities include maintaining competency and understanding of applicable laws & regulations governing release of PHI, providing support to non-ROI off-shift staff covering ROI duties, meeting productivity and customer service standards, independently participate in daily workflow, prioritizing requests, and troubleshooting routine issues producing medical records from the current EMR and applicable legacy systems.

  • 1. Processes and fulfills medical record audit requests received by mail, fax, phone, or approved electronic means, per HIM Payer Audit procedures and all applicable state and federal regulations governing release of patient records.
  • 2. Maintains competency in navigation of Epic, Data Ark, Prism, Quadramed, SCM, Centricity, Cerner, Meditech, and any other relevant legacy EMR system required to fulfill audit requests. Manages electronic work queue to prioritize and triage incoming right fax requests; assigns requests to next available staff member. Operates desktop scanner, and produces documents in format specified by requestor (electronic or paper).
  • 3. Adheres to applicable YNHHS policy, HIPAA regulations, Federal, and Connecticut statutes as pertains to releasing patient protected health information. Participates in continuing education to maintain knowledge. Seeks clarification from department leaders as needed.
  • 4. Demonstrates competency in evaluating and fulfilling payer audit requests including additional supporting documents, (e.g. CDI Queries and Coding Summaries). Ensures compliance with documentation checklist for specialized audit requests. Can accurately explain to requestors the process to submit an audit request including applicable fees.
  • 5. Ensures accuracy and quality by verifying: (1) documents released to requestors are for the correct patient and payer, (2) include the requested dates of service, (3) the provider of service, and (4) and all specified health record documentation retrieved is complete and digital images are legible.
  • 6. Follows established procedures to track the status of each request through closure including capturing page count and media type in the applicable ROI system(s).
  • 7. Reviews and manages the Inovolan web portal to support interoperability of high volume Risk Adjustment audits.
  • 8. Provides support to HIM Clinical Quality Specialist in extracting clinical data requested to support gaps in care per HEDIS guidelines.
  • 9. Meets current department quality and productivity standards, communicating opportunities for efficiency and barriers to department leaders as necessary.
  • 10. Works in collaboration with team members to ensure all priority and/or STAT requests are processed in a timely manner.
  • 11. Provides immediate support for site visits and/or surveys upon request of Regulatory Services. Rotates to any HIM/ROI service location as directed to maintain department coverage, meets customer service standards, and provides regulatory support.
  • 12. Applies YNHHS service excellence pledge in all interactions with customers, department leaders, and co-workers. Maintains composure and escalates difficult customer interactions to department leaders as appropriate.
  • 13. Demonstrates excellence in customer service and service recovery. Escalates customer service concerns which are unable to be mitigated to Payer Audit leadership.
  • 14. Alerts department leaders if anticipates fulfillment of any request will exceed the 30 days permitted by HIPAA or other deadline that would result in poor customer relations.
  • 15. Generates invoices for billable requests in compliance with YNHHS policy and department procedure.

    Other information:

    Associates degree in health care related field or equivalent release of health information experience.

    A minimum of two (2) years of health care related experience in either an ambulatory or hospital setting with direct experience in fulfilling release of information and customer service. Electronic medical record navigation and/or electronic data entry experience required. Alternatively, a minimum of one year specialized experience at YNHH as an HIM Release of Information Tech II qualifies an individual for this position.

    Knowledge of legal medical record requirements, HIPAA, forms and content. Capability to operate scanners, printers, fax machines and copiers. Strong computer skills. Superior verbal and written communication skills. Ability to efficiently organize, multi-task & prioritize work. Ability to learn new tasks quickly & flexibility to adjust to changing environment. Ability to interact professionally with co -workers and staff from other departments and vendors as needed.

    Incumbent held responsible for prompt, professional, and courteous customer service; provides service recovery as necessary to ensure customer expectations are met or exceeded. Ensures confidential, timely, and accurate issuance of requested medical information to appropriate parties or agencies. Escalates issues to Payer Audit leadership if unable to independently resolve customer concerns.

    Position requires use of good judgment, tact and the need to exercise discretion when dealing with customers (patients, physicians, attorneys, other hospital/health care providers, etc.) and in processing requests for medical records. Requires obtaining thorough knowledge of a variety of regulations (hospital, State/Federal) concerning the release of medical information. Must use good problem solving skills for novel or difficult requests. Must handle high volume of telephone inquiries. Ability to work as part of a team in a fast-paced, disruptive environment.

    Must be physically capable of walking, lifting, bending, and reaching.

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    Job Info

    Job: 4890

    Department: Payer Audit
    Category: Him/med Records
    Status: Part Time With Benefits
    Shift: DAYS
    Hours: 24.00

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