HealthCare Authorization, Insurance Verification, & Medical Billing Specialist
About The Position
The HealthCare Authorization, Insurance Verification, and Medical Billing Specialist is responsible for supporting the full revenue cycle functions related to client eligibility, authorization acquisition, and medical billing. This includes securing insurance authorizations, verifying eligibility, performing detailed billing reviews, assisting with claims processing, documenting all activities, and coordinating closely with internal staff, payers, and managed care entities to ensure accurate and timely reimbursement. Ensures all activities are performed in accordance with OIG compliance guidance, payer requirements, and internal controls designed to prevent fraud, waste, and abuse. Maintains accurate, complete, and timely documentation to support billing and reimbursement. Participates in audits, monitoring activities, and corrective action plans as required.
Requirements
- High School Diploma or GED
- Minimum of two (2) years of experience supporting medical billing and revenue cycle functions, including eligibility, authorizations, and claims review
- Strong planning and organizational skills; ability to work effectively with managers, peers, and external partners
- Knowledge of MassHealth Eligibility System, health insurance eligibility systems, and coverage processes
- Knowledge of Commercial and MassHealth coverage types, ACOs, and MCOs
- Experience communicating with insurers to secure authorizations and resolve coverage or billing issues
- Working knowledge of the healthcare authorization process from initiation through approval
- Ability to confirm and update accurate insurance information within the EHR
- Experience performing billing support functions, including reviewing client account and claim detail for accuracy, completeness, and compliance
- Strong computer skills, including proficiency with Excel or Microsoft Access for data entry, analysis, and reporting
Nice To Haves
- Bachelor’s degree or relevant education/training in third-party payer requirements, billing, or health administration
- Experience with Electronic Health Records (CareLogic)
- Knowledge of CSPECH, Stabilization, Recovery Coach, and other Behavioral Health services
- Knowledge of MassHealth Virtual Gateway
- Knowledge of HIPAA and 42 CFR Part 2
Responsibilities
- supporting the full revenue cycle functions related to client eligibility, authorization acquisition, and medical billing
- securing insurance authorizations
- verifying eligibility
- performing detailed billing reviews
- assisting with claims processing
- documenting all activities
- coordinating closely with internal staff, payers, and managed care entities to ensure accurate and timely reimbursement
- Ensuring all activities are performed in accordance with OIG compliance guidance, payer requirements, and internal controls designed to prevent fraud, waste, and abuse
- Maintaining accurate, complete, and timely documentation to support billing and reimbursement
- Participating in audits, monitoring activities, and corrective action plans as required
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
