Health Services Coordinator

Baystate Health • Springfield, MA

2d • Remote

About The Position

Baystate Health’s Health New England (HNE) is seeking a detail-oriented, service-focused Health Services Coordinator for its Utilization Management team in Springfield, Massachusetts. The coordinator serves as a resource for members, providers, and internal teams by helping coordinate service requests, communicate benefit and authorization decisions, and support access to appropriate healthcare services. The role works closely with Case Managers and other HNE departments to research issues, provide education, and help members navigate their healthcare benefits.

This is a full-time position scheduled for 40 hours per week, Monday through Friday, with rotating weekends. Training hours are 8:00 a.m. to 4:30 p.m.; after training, the schedule is 8:30 a.m. to 5:00 p.m. The position is based at 1 Monarch Place in Springfield, Massachusetts, with a remote work opportunity. Candidates must live in Massachusetts or Connecticut because occasional onsite meetings are required.

Requirements

• High school diploma or equivalent.
• At least 2 years of experience in a medical administrative role within a physician's office, clinic, medical facility, or the insurance industry.
• Knowledge of medical terminology or related training.
• Beginner to intermediate proficiency with Microsoft Word and Excel.
• Strong typing accuracy and attention to detail.
• Excellent problem-solving, organizational, and prioritization skills.
• Strong listening and communication skills, both over the phone and in person.
• Ability to work independently and collaboratively in a team environment.
• Ability to interact effectively with a diverse, multicultural membership.
• Must live in Massachusetts or Connecticut; occasional onsite meetings are required.

Responsibilities

• Review and process authorizations based on member benefits, established criteria, and applicable guidelines.
• Respond to Health Services-related inquiries from providers and members, providing information about benefits, eligibility, procedures, and authorization decisions.
• Complete authorization entry, generate correspondence, audit benefit information, and meet productivity and turnaround-time standards.
• Assist Case Managers with research, troubleshooting, correspondence, and administrative support related to member service requests.
• Provide education and assistance to Member Services, Provider Relations, Sales, and other HNE teams to help resolve complex issues and coordinate member care.
• Support the member appeals process, research claims questions, and help resolve benefit-related concerns.
• Explain criteria-based procedures, provide benefit information, and conduct outreach to connect members with available programs and resources.
• Assist with Medicare Advantage Health Risk Assessment data, government program requirements, and applicable CMS guidelines.
• Protect member confidentiality and follow HNE policies and applicable HIPAA, DOI, NCQA, and regulatory standards.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED