Third Party Claims Reviewer, Remote

The Opportunity

The Third Party Claims Reviewer functions under the general supervision of the payer unit Supervisor. This position is responsible for the billing, review, follow-up, and collection/resolution for the payers in the EPIC system.

Principal Duties

The Third Party Reviewer Uses 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

• Work directly out of the EPIC system
• Maintain records utilizing "shared file areas" or other mechanisms as appropriate
• Review assigned accounts by contacting various insurance carriers to ensure timely resolution of accounts
• Review and verify claim denials and appeals
• Create updates and document information relating to the financial status of accounts in the hospital billing systems
• Process denied/rejected claims
• Communicate effectively between colleagues, other units within the organization, and third parties
• Collect and verify medical records when necessary
• Identify procedural, system, or other issues as they occur and report to department supervisor or manager
• Meet established goals for quality and productivity as established by the unit
• Adhere to the organization's HIPAA Privacy guidelines
• Performs all other duties, assignments, and special projects as requested

Qualifications

• High school diploma or equivalent required
• Two years' experience as a patient account representative in a hospital or medical office setting 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. 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

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.