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

• Bachelors 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

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$79560.00 - $115720.80/Annual

Grade

7 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 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 Veterans 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 .

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

Job Tags

Full time, Remote work, Shift work

Similar Jobs