Third Party Claims Reviewer
Boston, MA 
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Posted 20 days ago
Job Description
Description

About Us

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.

The Opportunity
The Reviewer functions under the general supervision of the Unit Management Team. This position is responsible for the review, follow-up and collection/resolution of the MGH, BWH, NWH NSMC and BWF HSN / OGOV Receivable. This position is responsible for the review, follow-up and collection/resolution for all 3rd party payers in the EPIC systems.
Principal Duties and Responsibilities
* Review assigned accounts by contacting Medicare to ensure timely resolution of accounts.

* Create updates and document information relating to the financial status of accounts in the hospital billing systems.

* Contact patients and/or other third party representatives to secure additional information pertaining to reimbursement of accounts.

* Process rejected/adjusted claims through Medicare FISS system. And various payer websites.

* Communicates effectively with other PHS employees throughout the system.

* Performs all other duties and assignments as requested.

Qualifications
Qualifications

* Minimum of three years experience as a patient account representative in a hospital or medical office setting. High school diploma.

* Excellent interpersonal skills and strong team player. Knowledge of third party payer contracting language, terms and medical terminology.

* Competency with Microsoft Word and Excel.

EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.

Primary Location: MA-Boston-MGB Remote See Posting for Details
Other Locations: MA-Somerville-MGB Assembly Row
Work Locations:
MGB Remote See Posting for Details
399 Revolution Drive
Somerville 02145
Job: Auditing/Compliance
Organization: Mass General Brigham
Schedule: Full-time
Standard Hours: 40
Shift: Day Job
Posted Shift Description: M-F Eastern Business hours. Hybrid, bi-weekly, 2x a month onsite attendance at AR for business purposes. Shift starts will be determined after training; start times from 6 AM - 8:30 AM. Training M-F 8:30 AM - 3 PM, for first 4-5 weeks
Employee Status: Regular
Recruiting Department: MGB Central Billing Office
Job Posting: Apr 15, 2024


Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
High School or Equivalent
Required Experience
3+ years
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