PBS Reviewer, Sr.

About Us

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

General Summary/Overview

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. The reviewer will have the authority to remove or transfer accounts to bad debt. Verification process routinely includes contacting other departments at MGB/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents).

Principal Duties and Responsibilities

• Use NEHEN to locate active insurance coverage and provide timely and accurate account review/resolution of assigned accounts.
• 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.
• Work will be performed in various billing systems including, document imaging (Onbase), eligibility verification systems (NEHEN, payer web sites).
• Obtain information from internal third-party payer units, Group Practice Management, payers, patient employer group, and other hospitals to help resolve the patient’s account.
• 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
• Contact the guarantor for accounts that are selected for follow up to try and resolve the guarantor balance through collections or offering payment plan option
• 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.
• Transfer accounts to agencies including submission of claims to the state for Emergent/Urgent covered services, according state guidelines.
• Performs other duties, tasks or projects as assigned

Qualifications

• High School diploma or GED equivalent required

• Associates Degree preferred but not required

• Epic billing systems knowledge preferred

• Effective communication, organizational and problem solving skills required.

• 3-5 years relevant experience in customer service in a health care setting, knowledge of third party payment processes is desired.

Skills/Abilities/Competencies

• Knowledgeable on basic Medicare issues including Medicare as a Secondary Payer (MSP).

• Good verbal and written business communications skills sufficient to clearly document issues and communicate with patients.

• Comply with the all applicable MGB Patient Billing Office policies and procedures. Follow department attendance expectations and arrive for work well prepared at expected time. Attend required training.

• Intermediate skills in Excel and Outlook, sufficient to perform all routine tasks

• 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.