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, MGB 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.
Reporting to and working under the general direction of the Manager, Patient Accounts. The PBS Senior 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 our Collection Agencies to resolve patients accounts timely and ensure reports from the Agencies have correct information. The reviewer will also be responsible to remove or transfer accounts to bad debt. The PBS Senior Reviewer is also responsible for work assigned EPIC Work Queues. 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
Searching Health and Human Services/MMIS & Nehen websites for insurance coverage.
Utilize INET applications, to submit and process Special Circumstance Applications to Health Safety Net for Emergent Bad Debt account(s).
Submitting Emergent/Urgent covered services according to State guidelines. Processing bad debt adjustment and transferring account to agencies
Providing evidentiary to the State for Emergent/Urgent accounts through INET
Provide support for Medicare audits which may require documentation and policy/procedure verification
According to MGB policy/procedure, reviewing, transferring and returning accounts to outside collection agency's
The reviewer will have the authority to remove or transfer accounts to bad debt. Verification process routinely includes contacting other departments at MGB along with insurance agencies and collection agencies.
Use NEHEN 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 TRAC, QUIC, document imaging (Onbase), eligibility verification systems (NEHEN, payer web sites).
Effectively handle all communications, which may include correspondence (IBM/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 bankruptcy, settlement offers, and death certificates according to MGB policy/procedures and maintain HIPAA compliance
Back up for coordination of benefits, verification of co-payments/co-insurance/deductibles and verification/updates to demographic and fiscal registrations in order to verify the patient's responsibility for all outstanding balances.
Make appropriate updates to EPIC to ensure claims are processed appropriately including the completion of required supplemental information such as date(s) of employment/retirement, date of birth, sex in accordance with the Medicare questionnaire.
Obtain information from internal third-party payer units, Group Practice Management, payers, and other hospitals to help resolve the patient's account
Resolve issues with minimal supervisory involvement. Document all patient interactions and account actions in assigned account/work queues to establish a clear audit trail.
Performs other duties, tasks or projects as assigned.
High School diploma or GED equivalent required
Associates Degree preferred but not required
Epic billing systems knowledge required
Effective communication, organizational and problem solving skills required.
Proficient in Excel, Word and Microsoft Outlook
3-5 years relevant experience working in a health care setting, knowledge of third party payment processes is desired
Knowledgeable on basic Nehen, MMIS & other payer website
Knowledge of Medicare billing issues including Medicare as a Secondary Payer (MSP).
Good verbal and written business communications skills sufficiently to clearly document and communicate with patients.
Comply with the all applicable MGB policies and procedures. Follow department attendance expectations and arrive for work well prepared at expected time. Attend required training.
Ability to work in a high volume, fast paced business environment
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.