Billing Managed Care Coordinator Lead

Mass General Brigham•Boston, MA

1d•Remote

About The Position

The Billing Managed Care Coordinator Lead oversees prior authorization and referral requests for medical services. The role includes verifying insurance eligibility, coordinating specialty care referrals, reviewing medical necessity, and ensuring compliance with payer, company, and HIPAA requirements. The lead reviews, compiles, submits, and documents required medical records and authorization details in the EHR, maintaining accurate communication with payers and third-party administrators. The position leads and supports a team through cross-department collaboration, training and precepting new hires, and proactive and reactive audits. It also monitors workflows and dashboards, helps resolve complex authorization issues, and improves processes to support timely, compliant authorization handling. This is a 100% remote role for candidates residing in the United States and authorized to work there without current or future sponsorship.

Requirements

High school diploma or equivalent.
3–5 years of experience in prior authorization, medical billing, or a related healthcare role.
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, including the ability to interact effectively with providers, patients, and insurance representatives.
Proficiency in 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 and be authorized to work in the U.S. without current or future 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 workflow and adherence to policies and procedures.
Regularly review Epic and Tableau dashboards, including work queue monitoring reports, to forecast staffing needs.
Ensure compliance with payer requirements, healthcare regulations, and facility policies in prior authorization activities.
Ensure required information for tests and imaging is collected, reviewed, and submitted 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 enhance efficiency and reduce authorization turnaround times.
Address and resolve complex authorization denials and appeals, working with providers, patients, and payers to achieve favorable outcomes.
Collaborate with ordering clinicians, when needed, to ensure the proper CPT codes are submitted for prior authorization or referrals.
Refer patients to financial counseling as appropriate.
Conduct proactive and reactive audits to support timely processing, compliance, and continuous process improvement.