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Third Party Reviewer

3 months ago

Boston, United States Mass General Brigham Full time

**Third Party Reviewer**
- (3291288)

**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 Specialty Billing Department Supervisor/Manager. This position is responsible for the review, follow-up and collection/resolution for all 3rd party payers for both inpatient and outpatient for Out of State Medicaid in the EPIC systems

**Principal Duties and Responsibilities**
- Works Directly out of the EPIC system
- Reviews assigned accounts by contacting Out of State Medicaid 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**
- Minimum of two years’ experience as a patient account representative in a hospital or medical office setting
- High school diploma.
- Knowledge of Out of State Medicaid regulations.
- Competency with Microsoft Office
- EPIC experience a plus
- Excellent interpersonal skills and strong team player.
- Knowledge of third-party payer contracting language, terms and medical terminology

**EEO Statement**

**Primary Location** MA-Boston-MGB Remote See Posting for Details

**Other Locations** Massachusetts, 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 Days Eastern Business Hours required with stable work station, quiet and secure. Shifts M-F 7:30 - 4:00 or 8:00 - 4:30.

**Employee Status** Regular

**Recruiting Department** MGB Revenue Cycle Operations

**Job Posting** May 22, 2024