Third Party Reviewer at Mass General Brigham(PHS)

Posted in Other 11 days ago.

Location: Somerville, Massachusetts

Job Description:

About Us

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.

General Overview

The Third-Party Reviewer functions under the general supervision of the Medicaid/MassHealth Unit Supervisor/Manager. This position is responsible for the review, follow-up and collection/resolution for all 3rd party payers in the EPIC systems.

Principal Duties and Responsibilities

  • Works Directly out of the EPIC system

  • Reviews assigned accounts by contacting MassHealth 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.



  • Minimum of three years' experience as a patient account representative in a hospital or medical office setting. High school diploma.

  • Knowledge of Medicaid/ MassHealth 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.


  • Excellent interpersonal skills necessary to deal effectively with internal and external departments.

  • Must be able to work independently in a fast-paced environment.

  • Must be able to multi-task.

  • Computer skills include Outlook and Microsoft Office Suite.

  • Effective oral and written communication, organizational and problem-solving skills required.

  • HIPAA Privacy guidelines

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.
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