• Job Description

  Req#: 1164510
  !*!
  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
  Reporting to and working under the general direction of the Sr Manager, Patient Accounts. The PBS Reviewer resolves discrepancies or other issues with guarantor/patient demographics, and insurance coverage. Accounts are selected for review based on work files that are generated either manually or automatically in the EPIC billing system. Accounts may also be referred if they have failed billing requirements or if mail sent to the guarantor has been returned as undeliverable. The reviewer utilizes multiple electronic billing and payer website as well as knowledge of medical billing to resolve these discrepancies.
  Working with the Bad Debt team to resolve patients account timely and ensure claims are filed in a timely manner. The PBS Reviewer is also responsible for work assigned EPIC Work Queues, Accurint Report, Nehen/Trizetto Blast, Return Mail, CRM and Patient Outreach. Our goal is to resolve all of the patient’s concerns while maintaining positive relationships with the guarantor/patient by providing the best possible service to all our customers thereby enhancing the overall engagement with the patient.
  Principal Duties and Responsibilities
  • Verification/updates to demographic and insurance registrations in order to verify accurately bill all services rendered to patient.
  • Use NEHEN/TriZetto to locate active insurance coverage and provide timely and accurate account review/resolution of assigned accounts.
  • Work will be performed in various billing systems including, document imaging (Onbase), eligibility verification systems (NEHEN/TriZetto, MMIS and other payer web sites).
  • Work assigned work queues, update insurance and other demographic information on accounts assigned within EPIC work queues, following MGB policy/procedure
  • Effectively handle all communications, which may include correspondence (CRM), telephone and email, from patients and other departments within MGB.
  • Identify root cause(s) of guarantor/patient inquiries and report findings to management for appropriate resolution to future accounts. Follow up on individual issues to assure they are completed.
  • Record and handle accounts/communications of all return mail including deceased patient according to MGB policy/procedures and maintain HIPAA compliance
  • Contact the guarantor for accounts that are selected for follow up to try and resolve the guarantor demographic or discrepancy and provide guidance to patient as needed
  • Resolve issues with minimal external or supervisory involvement. Document all patient interactions and account actions in assigned accounts/work queues to establish a clear audit trail.
  • Performs other duties, tasks or projects as assigned.
  • Use/s 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
  !*!
  Qualifications
  • High School diploma or GED equivalent required
  • Epic billing systems knowledge preferred
  • Effective communication both oral and written
  • Detail oriented and organizational skills required
  • A combination of education and experience may be substituted for requirements
  !*!
  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.
  
  MGB Remote See Posting for Details (MGBRemoteSeePostingforDetails)
  399 Revolution Drive
  Somerville, 02145
  
  MGB Assembly Row (PHSSomervilleAssembly)
  399 Revolution Drive
  Somerville, 02145
  
  

• About the company

  Mass General Brigham is a Boston-based non-profit hospital and physicians network that includes Brigham and Women's Hospital and Massachusetts General Hospital, two of the nation's most prestigious teaching institutions.

Notice