Third Party Claims Reviewer, Hybrid at Mass General Brigham in Somerville, Massachusetts
Posted in Other about 4 hours ago.
Job 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 Third-Party Reviewer functions under the general supervision of the HSN/ Other Government Unit Supervisor/Manager. 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
- Works Directly out of the EPIC system
- Reviews assigned accounts by contacting HSN/ Other Government to ensure timely resolution of accounts
- Reviews and verifies claim denials and appeals
- 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 claims.
- Communicates effectively with other MGB employees throughout the system.
- Performs all other duties and assignments as requested.
Qualifications
Qualifications
- High school diploma or equivalent required
- 2 years experience as a patient account representative in a hospital or medical office setting preferred
- Knowledge of HSN/ Other Government regulations preferred
- EPIC experience preferred
- Knowledge of third party payer contracting language, terms, and medical terminology preferred
- Customer Service Experience required
Skills for Success
- Exceptional Customer Service abilities
- Competency in MS Office applications: Word and Outlook
- Ability to handle multiple tasks having complex procedural steps in a timely manner
- Exceptional interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
- Ability to work self-sufficiently on assigned tasks without supervision
- Effective verbal and written communication, organizational and problem-solving skills required
Working Conditions
- M-F Eastern Business hours required. Hybrid model includes onsite days, as planned required weekly, and Remote work requires stable, secure, quiet, HIPPA compliant work station.
- Training is required 8a-4pm ET M-F, working shifts fall between 6a and 6p ET
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 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.
