Billing Managed Care Coordinator in Boston, Massachusetts

Billing Managed Care Coordinator

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…