Third Party Reviewer
Third Party Reviewer
Posted on :
09-04-2025
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
09-04-2025
Job Description
About Us
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.
As a notforprofit 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 Womens 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 healthrelated entities. Several of our hospitals are teaching affiliates of Harvard Medical School and our system is a national leader in biomedical research.
Were focused on a peoplefirst culture for our systems patients and our professional family. Thats 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 developmentand 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.
Were focused on a peoplefirst culture for our systems patients and our professional family. Thats 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 developmentand 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.
General Overview
The Third Party Reviewer under the general supervision of the Unit Supervisor is responsible for the reviewing processing and resolution of the Transplant and In Vitro Fertilization receivable for the Massachusetts General Brigham and Womens and Faulkner Hospitals.
Responsibilities
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.
Initiate disbursements to physicians organizations per established procedures and processes. Liaise with these organizations to establish coordinated collection effort.
Identify procedural system or other issues as they occur and communicate details to department supervisor or manager.
Maintain records utilizing shared file areas or other mechanisms as appropriate.
Special projects as assigned.
Assist in trueups of the IVF and transplant receiveable.
QualificationsA minimum of two years Patient Accounting experience or similar background with review work.
A High school diploma or equivalent required.
Associated Degree preferred
Skills/Abilities/Competencies
Strong proficiency in MS Office applications.
Word Excel Outlook required; strong written and verbal skills.
Ability to handle complicated account problems in a timely manner.
Ability to handle multiple tasks having complex procedural steps.
Employment Type
Full-Time
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