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Third Party Reviewer

3 months ago

Somerville, Massachusetts, United States Mass General Brigham Full time

About the Job Title: Third Party Reviewer at Mass General Brigham

As a not-for-profit organization, Mass General Brigham is dedicated to providing support for patient care, research, teaching, and community service by driving innovation within our system.

Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham backs a comprehensive range of care services such as community and specialty hospitals, managed care, physician networks, community health centers, home care, and other health-related entities. Many of our hospitals are affiliated with Harvard Medical School, and our system holds a prominent position in biomedical research at a national level.

We foster a culture that prioritizes people both among our patients and our professional community. To support this, we offer our employees various pathways to fulfill their potential. Mass General Brigham is dedicated to aligning the personal goals of our staff with projects that match their skills, establishing an environment that enables our managers to serve as reliable mentors. We encourage each team member to take charge of their personal growth, celebrating achievements at every stage.

Our staff exemplify the values of Mass General Brigham in their decision-making, actions, and conduct. These values not only inform how we carry out our tasks—Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk—but also how we interact with one another—Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Job Description

The Reviewer operates under the supervision of the Unit Manager and is tasked with reviewing, following up, and managing the NWH and NSMC Medicare receivables.

  • Review assigned accounts by communicating with Medicare to ensure prompt resolution.
  • Update and document account financial status within hospital billing systems.
  • Contact patients or third-party representatives to gather additional reimbursement-related information.
  • Handle rejected/adjusted claims through the Medicare FISS system and various payer platforms.
  • Efficiently collaborate with other PHS staff across the network.
  • Handle additional duties and tasks as assigned.

Qualifications

  • Minimum of three years of experience as a patient account representative in a hospital or medical office setting, with a high school diploma.
  • Strong interpersonal skills and a collaborative team player. Familiarity with third-party payer contract terminology, language, and medical jargon.
  • Proficiency in Microsoft Word and Excel.