Third Party Reviewer

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POST DATE 8/18/2016
END DATE 10/13/2016

Partners HealthCare(PHS) Somerville, MA

Somerville, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED


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 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 health-related 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 people-first 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.

Responsible for accurate and timely follow up of all unpaid claims or incorrectly paid/rejected claims monthly until final resolution.


Will inform management in a timely manner of issues, problems, and complaints that arise with staff and customers.

Responsible for timely and accurate resolution of Accounts Receivable for assigned area.
Meets and exceeds short and long term goals and objectives as established for the work unit. Demonstrates the ability to function independently, shows initiative, and is creative to continuously improve services, processes and other activities that affect quality.
Answers telephone inquiries from various payors, management, physicians offices and customers.
Responsible for analyzing and processing credit balances due to insurance overpayments and posting issues.
Analyze and resolve any correspondence pertaining to each area of responsibility.
Follows departmental policies and procedures to ensure accuracy and efficiency of patient accounting duties.
Recommends operational changes to improve efficiency /effectiveness of work unit.
Remains knowledgeable and current on third party regulations, registration, coding applications, requirements, and guidelines at the federal, state, and local levels.
Enhances professional growth and development through seminars, conferences, and professional association activities.
Contributes to meeting all monthly and year-end fiscal closing deadlines.
Interface with other department personnel within the Partners Health Systems Entities to maximize support for department functions. Develops and maintains working relationship with peers from payors, vendors, and outside agencies.
Other duties as assigned by the department manager/supervisor within the scope of the position.

Technical Job Skills

Responsible for a working knowledge of the functionality of the Hospital Operating System or other contributory operating systems as it impacts the department.

Customer Service Responsibilities:
Displays courteous and professional behaviors and attitudes to all customer groups.
Treats others with dignity, respect, and compassion. Respects privacy of information and exercises good judgment about the dissemination of confidential information.
Maintains open and honest communications with all customer groups in order to foster an effective service environment.
Anticipates and responds to needs of others for information and assistance by using clear, concise language.
Exhibits commitment and pride through personal example and actions and by speaking positively about Partners Health System.
Serves as a role model to fellow employees by supporting the Service Excellence Program, Diversity Program, and other PHS mandated initiatives and encourages others to do the same.
Takes the initiative to meet customers needs and solve customers problems, or find someone who can.

Reports directly to the department supervisor. Must have ability to work independently with minimal supervision


High School diploma or general education degree (GED).

One year related medical billing experience and/or training, or equivalent combination of education and experience.

Knowledge of job related regulations and requirements.
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.