As a not-for-profit organization, Partners HealthCare 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, Partners HealthCare 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. Partners HealthCare 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 Partners HealthCare 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 Third Party Reviewer under the general supervision of the Unit Coordinator and Supervisor is responsible for the reviewing, processing and resolution of the Transplant Center of Excellence claims, contracted Hospice, National Marrow Donor, New England Organ Donor and IVF receivable for the Partners Health Care.
Principal Duties and Responsibilities
1. Resolve billed claims. Calculate payable portion per applicable contract and utilize available tools to secure proper payment from payer. This includes contacting payer as needed and reviewing contract and billing terms, as well as patient case histories.
2. Initiate disbursements to physicians' organizations per established procedures and processes. Liaise with these organizations to establish coordinated collection effort.
3. Maintain records utilizing "shared file areas" or other mechanisms as appropriate.
4. Special projects, as assigned.
• A minimum of two years Patient Accounting experience or similar background with review work. • A High school diploma or equivalent required. Associated Degree preferred
• Computer skill must include: Outlook, Word, and Excel.
• Excellent interpersonal skills necessary to deal effectively with fellow department employees, hospital staff, physicians, department heads, and patients.
• Must be able to work independently in a fast-paced environment.
• Ability to handle multiple tasks having complex procedural steps
EEO Statement Partners HealthCare 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. Partners Healthcare System Inc. is acting as an Employment Agency in relation to this vacancy.
MGH Institute of Health Professions, founded by Massachusetts General Hospital in 1977, is an innovative and independent graduate school in Boston that is a member of Partners HealthCare. A progressive leader in developing comprehensive models of health care education, the MGH Institute prepares advanced practice professionals in the fields of nursing, physical therapy, occupational therapy and communication sciences and disorders through a distinctive combination of academic study, clinical practice, and research. More than 1,200 students are enrolled in graduate level and certificate programs, with an increasing number of courses available online. The Institute is accredited by the New England Association of Schools and Colleges (NEASC).