Billing Managed Care Coordinator

Site: The Brigham and Women's Hospital, Inc.

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Job Summary

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.

Qualifications

• High School Diploma or equivalent required.
• Associate or bachelor’s degree in a related field preferred.
• 2–3 years of experience in managed care billing, authorizations, referrals, or revenue cycle operations required.

Knowledge, Skills, and Abilities:

• Knowledge of insurance authorization, referral, and reimbursement processes
• Familiarity with EPIC and payer verification systems (e.g., NEHEN) preferred
• 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

Key Responsibilities:

Authorization, Referral, and Eligibility Management

• 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

Billing & Reimbursement Support

• 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

Collections & Financial Coordination

• 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

Operational Workflow Support

• 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

Collaboration & Communication

• 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

Process Improvement & Quality

• 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

Training & Documentation Support

• 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

Other Duties

• 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)

Additional Job Details (if applicable)

Physical Requirements

Standing Occasionally (3-33%)

Walking Occasionally (3-33%)

Sitting Constantly (67-100%)

Lifting Occasionally (3-33%) 20lbs - 35lbs

Carrying Occasionally (3-33%) 20lbs - 35lbs

Pushing Rarely (Less than 2%)

Pulling Rarely (Less than 2%)

Climbing Rarely (Less than 2%)

Balancing Occasionally (3-33%)

Stooping Occasionally (3-33%)

Kneeling Rarely (Less than 2%)

Crouching Rarely (Less than 2%)

Crawling Rarely (Less than 2%)

Reaching Occasionally (3-33%)

Gross Manipulation (Handling) Constantly (67-100%)

Fine Manipulation (Fingering) Frequently (34-66%)

Feeling Constantly (67-100%)

Foot Use Rarely (Less than 2%)

Vision - Far Constantly (67-100%)

Vision - Near Constantly (67-100%)

Talking Constantly (67-100%)

Hearing Constantly (67-100%)

Remote Type

Hybrid

Work Location

45 Francis Street

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$22.22 - $31.71/Hourly

Grade

4At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

2200 The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.