![Partners HealthCare](https://media.trabajo.org/img/noimg.jpg)
PreVisit Clinical Review Specialist
2 months ago
Description
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Overview
The Population Health Management (PHM) department at Mass General Brigham aims to deliver health and healthcare for all by translating the evolving needs of the healthcare landscape into innovative solutions to better serve individuals, communities, and organizations.
In the healthcare industry, we are in a time like no other. Experts estimate that healthcare will evolve more in the next few years than it has in the last 50 years. We have seen governments, employers, and families struggle in the face of rising healthcare costs and a fragmented healthcare system. Patients and communities need more convenient, more affordable, and higher quality care.
We are building a team that can reimagine healthcare and design care models that meet the needs of the people we serve. We are bringing a fresh perspective and a unique approach to create impact for the greater good. By bringing together people from various disciplines and ideas from different industries, we’re seeking to address the complex challenges within our healthcare system and leaning forward into a new era of healthcare.
Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions through comprehensive chart review combined with review of coding output data sources (internal and external claims) that results in improvement in the overall quality, completeness and accuracy of problem lists, visit documentation and disease registry assignments. The CRS utilizes both clinical and coding knowledge of Hierarchical Condition Categories (HCCs) to inform accurate and appropriate diagnosis considerations for suspect condition identification and recapture opportunities. This role serves to educate providers and the clinical care team on all aspects of risk capture and linkages with quality.
Principal Duties and Responsibilities
Drive Clinical Delivery
• Performs accurate and timely pre-visit review of selected ambulatory encounters to identify opportunities to recapture medical conditions that meet criteria as HCC diagnoses and to capture new, suspected HCC conditions.
• Accurately interprets clinical information in the medical record, evaluating clinical indicators to identify potential diagnoses
• Presents clear HCC Consideration Communication to provider and educates providers to obtain greatest possible diagnostic specificity to accurately reflect the patient’s condition(s)
Identify Education Opportunities
• Identifies themes through chart review that might present education opportunites for individual or groups of providers
• Gathers feedback from periodic post-visit chart reviews and incorporates these learnings into educational opportunities with providers
• Identifies opportunity for Process Improvement and Quality Improvement, as needed
Foster collaborative relationships across the enterprise
• Communicates appropriately and compliantly with physician or care team through Epic resources to improve medical record documentation
• Participates in ambulatory unit/organizational programs and meetings as needed
• Maintains professional competency by keeping abreast of new coding issues and guidelines. Attends classes and meetings as assigned. Reviews professional CDI and coding literature regularly
• Maintains clinical licensure (e.g. RN, PA, NP) to practice in the Commonwealth of MA and completes all required Organizational Competencies and trainings
• Meets with providers on an as-needed basis to address concerns orareas of opportunity, and performs chart reviews as needed
• Maintains good rapport and professionalrelationships, as outlined in MGB Code of Conduct –
• Approaches conflict in a constructive manner, helps identify problems, offer solutions and participate in resolution
• Responsible to perform any and all other assigned duties as requested
Qualifications
Qualifications
• Bachelors’ Degree in Nursing, Physician Assistant or other clinical heathcare related field required
• Minimum three (3) - five (5) years’ experience required in either clinical nursing, case management, Outpatient Coding, Utilization Review, Physician Assistant or other clinical disciplines with either coding or CDI experience however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements.
• Current licensure in the state of employment as an RN, NP, PA, or licensure in the specific medical field associated with a Doctorate degree required
• 2 years’ experience in Primary Care, medical coding, risk adjustment or CDI preferred
• Current certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS-O or CDEO) highly preferred or appropriate certification within 2 years of employment
• Certification in medical coding and or risk adjustment (i.e., CRC, CPC, CCS, or CCS-P or other pertinent to outpatient) preferred
• Strong PC skills / Microsoft applications, including Excel, Access, Project, PowerPoint
Skills, Abilities and Competencies
Skills for Success
• Working knowledge of the Medicare Advantage reimbursement system, Risk-based Contracts and HCC Coding
• Superior analytic and problem-solving skills with a high value in data integrity and analytic accuracy
• Ability to conduct detailed analysis as well as distill relevant findings for presentation to a high-level audience
• Creativity and enthusiasm for developing and implementing new programs
Team Player
• An inclusive individual who thrives in a highly matrixed, collaborative, team-oriented environments
• Strong interpersonal and team building skills. Ability to get work done through others, even if there is no direct reporting relationship
• Ability to successfully collaborate with others of different skill sets, backgrounds, and levels within and external to the organization
Commitment to Quality
• Accountable for delivering high quality work. Act with a clear sense of ownership
• A hybrid work model, with two days per month onsite at Assembly Row for PHM meetings.
-
PreVisit Clinical Review Specialist
2 months ago
Somerville, United States Mass General Brigham Full timePreVisit Clinical Review Specialist-(3293627) Description As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a...
-
Clinical Applications Specialist
4 weeks ago
Somerville, United States Deep Health Somerville Full timeJob DescriptionJob DescriptionResponsibilitiesArtificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better...
-
Clinical Applications Specialist
3 months ago
Somerville, United States Deep Health Somerville Full timeJob DescriptionJob DescriptionResponsibilitiesArtificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better...
-
Human Research Compliance and Auditing Specialist
3 months ago
Somerville, United States Mass General Brigham Full timeHuman Research Compliance and Auditing Specialist-(3286936) Description Come join our team and play a pivotal role in promoting and ensuring an environment where human subject research is conducted according to the highest standards! Our Team Our Human Research Affairs Compliance and Education Office was established in June 1999 as the Quality...
-
Prior Authorization Specialist, Assembly Row
2 weeks ago
Somerville, United States Mass General Brigham Full timeDescription: What does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR...
-
Prior Authorization Specialist, Assembly Row
3 months ago
Somerville, United States Mass General Brigham Full timeWhat does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and sur Authorization, Specialist, Assembly, Clinical, Customer Service, Media Manager, Healthcare
-
Prior Authorization Specialist, Assembly Row
3 weeks ago
Somerville, United States Brigham & Women's Hospital(BWH) Full timeWhat does a Prior Authorization Specialist do?The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and...
-
Prior Authorization Specialist, Assembly Row
2 months ago
Somerville, United States Brigham & Women's Hospital(BWH) Full timeWhat does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and...
-
Prior Authorization Specialist, Assembly Row
4 weeks ago
Somerville, United States Mass General Brigham Full timeDescription: What does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR...
-
Prior Authorization Specialist, Assembly Row
2 months ago
Somerville, United States Brigham & Women's Hospital(BWH) Full timeWhat does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and...
-
Prior Authorization Specialist, Assembly Row
2 weeks ago
Somerville, United States Brigham & Women's Hospital(BWH) Full timeWhat does a Prior Authorization Specialist do?The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and...
-
Pre-clinical Scientist
3 months ago
Somerville, United States Gan & Lee Pharmaceuticals Full timeJob DescriptionJob DescriptionSummaryThis position reports to the department head of non-clinical sciences. The Non-Clinical Scientist provides the overall leadership regarding the non-clinical scientific and strategy for an asset and is accountable for meeting all non-clinical objectives for the program. Most of the non-clinical work will be done in...
-
Somerville, United States Smart Bot Systems Full timeJob DescriptionJob DescriptionHi,Hope you are doing well!Please find the below job description & please share your updated resume.Role: Validation specialistLocation: Raritan, NJ HybridDuration: Long termJob Details:10+ years' experience in Computer System Validation or Quality management or Business Analysis in GxP application areaHas working experience...
-
Recovery Specialist
1 month ago
Somerville, United States Bay Cove Human Services Full timeRecovery Specialist - Summit Avenue - Full Time - Overnights Somerville, MA, USA Req #2737 Tuesday, July 9, 2024 Bay Cove Human Services' mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the...
-
Recovery Specialist
3 months ago
Somerville, United States Bay Cove Human Services Full timeRecovery Specialist - Men's Residence - Highland Avenue Department Somerville, MA, USA Req #2032 Wednesday, March 20, 2024 Bay Cove Human Services’ mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the...
-
Collection Specialist
2 months ago
Somerville, United States CATALDO AMBULANCE Full timeJob DescriptionJob DescriptionCollection SpecialistI. Job SummaryThe Collection Specialist is responsible for collections of outstanding private invoices from the existing client base, resolving customer billing problems and reducing accounts receivable delinquency. This position will report to the Revenue Cycle Manager and is located out of our Somerville,...
-
Recovery Specialist
3 months ago
Somerville, United States Bay Cove Human Services Full timeRecovery Specialist - Men's Residence - Highland Avenue Department Somerville, MA, USA Req #2032 Wednesday, March 20, 2024 Bay Cove Human Services' mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people...
-
Sustainable Solutions Specialist
1 week ago
Somerville, Massachusetts, United States Triumvirate Environmental Full timeSustainable Solutions SpecialistTriumvirate Environmental, one of the largest environmental services firms in North America, is seeking a Sustainable Solutions Specialist for our Platinum Accounts team.This detail-oriented individual will have the opportunity to become an internal expert level resource in all things waste relatedTriumvirate provides leading...
-
Recovery Specialist
4 weeks ago
Somerville, United States Bay Cove Human Services Full timeRecovery Specialist - New Day - Full Time - Evenings Somerville, MA, USA Req #2790 Tuesday, July 9, 2024 Bay Cove Human Services' mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the...
-
Recovery Specialist
1 month ago
Somerville, United States Bay Cove Human Services, Inc. Full timeBay Cove Human Services' mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the challenges associated with developmental disabilities, mental illness, substance use disorders, and homelessness at more than 175 program...