Billing Managed Care Coordinator

Mass General Brigham•Boston, MA

3d•Hybrid

About The Position

The Billing Managed Care Coordinator supports the Department of Neurology’s revenue cycle operations, with a primary focus on managed care processes including referrals, prior authorizations, eligibility, and denial resolution. This role reports to the Senior Administrative Director and works under the day-to-day guidance of the Lead Managed Care Coordinator, in close collaboration with Practice Administrators and clinical teams. The coordinator is responsible for ensuring timely and accurate processing of authorizations and referrals, supporting billing workflows, and helping optimize reimbursement while maintaining a high standard of patient experience. The role requires strong attention to detail, effective communication, and the ability to navigate complex payer requirements.

Requirements

High School Diploma or equivalent required.
2–3 years of experience in managed care billing, authorizations, referrals, or revenue cycle operations required.
Knowledge of insurance authorization, referral, and reimbursement processes
Strong organizational skills with high attention to detail and accuracy
Ability to analyze information, identify issues, and support resolution within established workflows
Effective interpersonal and communication skills (phone, written, and in-person)
Ability to manage multiple tasks and prioritize in a fast-paced environment
Ability to work both independently and collaboratively within a team setting
Proficiency in standard computer applications and healthcare systems
Professional demeanor with ability to handle sensitive information with discretion

Nice To Haves

Associate or bachelor’s degree in a related field preferred.
Familiarity with EPIC and payer verification systems (e.g., NEHEN) preferred

Responsibilities

Obtain insurance authorizations prior to initiation of patient services
Ensure all required insurance referrals are received, complete, and accurately documented
Perform demographic and insurance eligibility checks in EPIC, NEHEN, and other payer systems; update or escalate discrepancies
Facilitate referral and prior authorization requests with payers and specialty pharmacies via phone, fax, and payer portals
Maintain accurate and timely documentation of all authorization and referral activity in EPIC
Be up to date on rules and eligibility of patient plans from managed care organizations
Monitor and take action on work queues related to missing authorizations, referrals, and denials. Must be done in appropriate timeframe to ensure it is done within the standard timeframe to resubmit.
Partner with Lead managed care coordinator and/ or billing teams to resolve authorization- and referral-related denials and support reprocessing or appeals
Support collection workflows for patient responsibility, including co-insurance, deductibles, and self-pay balances where applicable
Assist in identifying and escalating payer or patient-related issues that may impact reimbursement
Follow established department workflows and managed care processes
Scan provider schedules for non-contracted plans and escalate issues to Practice Administrators or Lead Coordinator
Maintain up-to-date tracking mechanisms and records of managed care activities (authorizations, referrals, denials)
Participate in Department Appointment Review (DAR) follow-up activities where applicable
Take direction from team lead and collaborate with team members to review, adopt and maintain workflows and best practice
Serve as back up to other Billing managed care coordinators and other administrative staff
Work closely with Practice Administrators, registration teams, billing staff, and clinical teams to ensure accurate information flow
Communicate clearly with patients regarding authorization requirements, status updates, and responsibilities related to their care
Serve as a resource for routine managed care process questions and escalate complex issues to the Lead Managed Care Coordinator
Serve as back up to other staff
Identify workflow inefficiencies and communicate opportunities for improvement to the Lead and leadership team
Support implementation of standardized workflows, tools, and best practices across sites
Maintain working knowledge of payer policies, billing requirements, and system updates
Support training and onboarding of new staff as directed by the Lead Managed Care Coordinator
Adhere to and help maintain departmental policies, procedures, and workflow documentation
Attend departmental and practice meetings as required
Ensure compliance with all hospital, state, and federal regulations (including HIPAA and Joint Commission standards)
Perform other duties as assigned, that may include but not limited to supporting provider(s)