Key Facts

Remote From:

Full time

Senior (5-10 years)

English

Hard Skills

Appeals Electronic Health Record Applications Billing Forensic Accounting Auditing Nurse Licensure Compact Database Reporting Software Auditing Clinical Nursing Auditing Clinical Data Analysis Medical Expense Performance Reporting Systems Cross-Functional Collaboration

Other Skills

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Spreadsheets
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Quality Assurance
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Communication
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Analytical Skills
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Training And Development
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Organizational Skills
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Detail Oriented
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Constructive Feedback
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Social Skills

Brigham and Women's Hospital

About Brigham and Women's Hospital

Boston's Brigham and Women's Hospital (BWH) is an international leader in virtually every area of medicine and has been the site of pioneering breakthroughs that have improved lives around the world. A major teaching hospital of Harvard Medical School, BWH has a legacy of excellence that continues to grow. With two outstanding hospitals, over 150 outpatient practices, and over 1,200 physicians, we serve patients from New England, throughout the United States, and from 120 countries around the world. The BWH name is a reflection of our history. In 1980 three of Boston’s oldest and most prestigious Harvard Medical School teaching hospitals - the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women – merged to form Brigham and Women’s Hospital. As a national leader in improving health care quality and safety, we have helped to develop some of the industry’s best practices including computerized physician order entry (CPOE) to prevent medication errors. The CPOE is now a nationally-accepted safety practice. The BWH Biomedical Research Institute (BRI) is one of the most powerful biomedical research institutes in the world and the second largest recipient of National Institutes of Health (NIH) funding among independent hospitals in the United States. BWH has long had great success in research as measured by the number of important discoveries made, the size and scope of its research portfolio and the volume of publications annually. BWH is a training ground for physicians, nurses, and allied health professionals. We have 1,100 trainees in over 140 of the most sought after training programs in the world, and also host Harvard Medical School students in rotations throughout our programs. As our global health services expand, our clinical trainees have rich opportunities to contribute and learn in challenging environments around the world. Brigham and Women's Hospital is an EEO, AA, VEVRAA Employer.

Founded: 2018

Company size: 10001

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Job description

Site: Mass General Brigham Incorporated

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

The Senior Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits conducted at Mass General Brigham (MGB) facilities in accordance with the MGB Charge Audit Policy and established departmental policies/procedures. The Senior Nurse Reviewer plays an important role in appealing challenges to charging policy and practice. The increased use of pre- and post-payer audits impacts MGB net revenue, to which the incumbent responds.

Essential Functions

-Coordinates the scheduling of audits with external third-party audit representatives/payors to initiate the audit process.

-Prepares detailed packages for cases selected by audit representatives, including necessary documents needed to initiate the audit process.

-Prepares audit responses and appeals for complex charge and forensic audits.

-Documents, summarizes, and defends audit findings in a clear, concise, and effective manner to preserve MGB appeal rights.

-Conducts post-audit research to support and defend cited charges by obtaining additional documentation.

-Updates internal systems used for tracking and reporting findings, including but not limited to patient accounting systems, spreadsheets, and databases, to facilitate monthly management reporting.

-Provides subject matter knowledge on various billing, coding, and clinical topics to the audit representatives and other key customers as needed.

Qualifications

Bachelor's Degree in Nursing required
Registered Nurse [RN - MA State License] - required
3+ years of experience in clinical nursing required
2+ years of experience in a quality assurance or clinical review role required

Skill for Success

It is essential that the candidate possesses strong appeal writing experience, as this skill is critical for successfully supporting and defending clinical charge audit findings during the appeals process.
Strong analytical skills with the ability to interpret clinical data and identify trends.
Excellent communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams.
Proficient in electronic health record (EHR) systems and clinical documentation tools.
Strong organizational skills and attention to detail.
Ability to provide constructive feedback and facilitate training for nursing staff.

Working schedule:

Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working station

Additional Job Details (if applicable)

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$79,560.00 - $115,720.80/Annual

Grade

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

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.

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