Managed Care Services Rep

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Sep 09, 2025
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. -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. Education High School Diploma or Equivalent required and Associate's Degree Related Field of Study preferred. Experience Previous experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing 2-3 years required Knowledge, Skills and Abilities - 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. 32-hour week position, shifts between 8 AM-5 PM M-F EST Remote position: Quiet, secure, stable, compliant work station required Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.