Insurance/Authorization Review

Mass General Brigham•Newton, MA

3d•Onsite

About The Position

The Insurance/Authorization Review role supports patients through the insurance authorization process and helps ensure timely, accurate reimbursement for medical services. The position works with patients, healthcare providers, insurance companies, and billing and coding staff to verify coverage, obtain and review authorizations, clarify benefits, and resolve authorization issues. It does not involve direct patient care. The position is based onsite at Newton-Wellesley Hospital, 159 Wells Avenue, Newton, Massachusetts. The schedule is 8:00 a.m. to 4:30 p.m., 40 hours per week, on the day shift.

Requirements

High school diploma or equivalent required; experience cannot substitute for the required education.
2–3 years of healthcare insurance billing experience required.
Strong knowledge of insurance verification, claims processing, and reimbursement practices.
Understanding of insurance coverage, benefit structures, and claim submission requirements.
Attention to detail and accuracy in data entry, documentation, and claim submissions.
Effective communication and interpersonal skills, including the ability to explain complex insurance and billing concepts to patients and healthcare providers.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

Nice To Haves

Associate’s degree in Healthcare Management or a related field preferred.

Responsibilities

Verify insurance coverage for services, procedures, and treatments.
Collect and update patient insurance information, including policy numbers, effective dates, and authorization details.
Work with insurance companies to obtain or clarify authorizations, including pre-approvals and pre-certifications.
Partner with billing and coding staff to support accurate, timely claim submissions.
Coordinate prior authorizations for procedures, tests, surgeries, and other services requiring approval.
Review authorization-related insurance denials, gather supporting documentation, and collaborate with healthcare providers on appeals and resubmission of authorization requests as needed.
Help patients understand their insurance coverage, benefits, and authorization requirements.