Billing Managed Care Coordinator Lead

Mass General Brigham•Boston, MA

3d•$26 - $36•Remote

About The Position

The Billing Managed Care Coordinator Lead oversees prior authorization and referral requests for medical services, including insurance eligibility verification, specialty care referrals, medical necessity review, and compliance with payer, company, and HIPAA requirements. The role reviews, compiles, submits, and documents required medical records and authorization details in the EHR, while maintaining accurate communication with payers and third-party administrators. The position leads and supports a team, collaborates across departments, precepts new hires, and conducts proactive and reactive audits to support timely processing, compliance, and continuous process improvement. It oversees daily operations of the prior authorization and referral department and works to resolve complex authorization issues, denials, and appeals. This is a 100% remote position; candidates must reside in the United States. The schedule is Monday through Friday, 7:30 a.m. to 4:00 p.m., with 40 scheduled weekly hours. Patient care is not required.

Requirements

High school diploma or equivalent.
At least 3 years of healthcare experience in prior authorization, medical billing, or a related healthcare role; the stated required range is 3–5 years.
1–2 years of Epic experience.
In-depth knowledge of prior authorization processes, payer requirements, and healthcare regulations.
Strong leadership, management, and team-building skills.
Excellent communication and interpersonal skills for interacting with providers, patients, and insurance representatives.
Proficiency with electronic health record systems and prior authorization software.
Strong analytical and problem-solving abilities, attention to detail, and organizational skills.
Ability to work in a fast-paced environment.
Must reside in the United States.
Must be authorized to work in the United States without current or future visa sponsorship.

Nice To Haves

Associate’s degree in a related field.
1–2 years of leadership or supervisory experience.

Responsibilities

Oversee daily operations of the prior authorization and referral department.
Lead, mentor, and train team members, ensuring efficient workflows and adherence to policies and procedures.
Review Epic and Tableau dashboards, including work queue monitoring reports, to forecast staffing needs.
Ensure prior authorization activities comply with payer requirements, healthcare regulations, and facility policies.
Collect, review, and submit required information for tests and imaging accurately and promptly to insurance companies and other payers.
Inform patients of authorization concerns before admission or procedures and coordinate with appropriate parties to facilitate authorization.
Collaborate with other departments and offices to resolve complex authorization issues.
Develop and implement process improvements to increase efficiency and reduce authorization turnaround times.
Resolve complex authorization denials and appeals by working with providers, patients, and payers.
Collaborate with ordering clinicians when needed to ensure the correct CPT codes are submitted for prior authorization or referrals.
Refer patients to financial counseling when appropriate.
Precept new hires and conduct proactive and reactive audits to support timely processing, compliance, and continuous improvement.