Managed Care Services Rep

Mass General Brigham•Somerville, MA

1d•Remote

About The Position

Responsible for serving as a liaison between the hospital, insurance companies, and patients to ensure proper coordination and reimbursement for healthcare services. This role verifies insurance coverage, obtains pre-authorization for medical procedures, and facilitates timely billing and payment processes. This role also educates patients about their insurance benefits and assists in resolving any insurance-related issues or disputes.

Requirements

High School Diploma or Equivalent required
Associate's Degree Related Field of Study preferred
Previous experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing 2-3 years required
In-depth knowledge of health insurance plans, including managed care, PPOs, HMOs, and Medicare/Medicaid.
Familiarity with medical terminology, coding systems (such as ICD-10 and CPT), and healthcare billing processes.
Strong interpersonal and communication skills to effectively interact with patients, insurance companies, and healthcare professionals.
Detail-oriented with excellent organizational and problem-solving abilities.
Proficient in using computer systems and software applications related to insurance verification, billing, and claims processing.
Ability to handle sensitive and confidential information with utmost professionalism and discretion.

Responsibilities

Verify insurance coverage and eligibility for patients prior to medical procedures or hospital admissions.
Obtain pre-authorization from insurance companies for various medical procedures, surgeries, and diagnostic tests.
Collaborate with healthcare providers, including physicians and nurses, to ensure accurate and complete documentation for insurance claims.
Communicate with insurance companies to resolve any coverage issues or denials, advocating for the best interests of the hospital and patients.
Educate patients about their insurance benefits, coverage limitations, and financial responsibilities.
Assist patients in understanding and navigating the insurance claim process, including explanation of benefits (EOB) and billing statements.
Process and submit insurance claims accurately and in a timely manner, adhering to industry regulations and guidelines.