[Hiring] Managed Care Services Representative @Mass General Brigham

Role Description

The Managed Care Services Insurance Verification Representative is vital for the team, serving as a liaison between the hospital, insurance companies, and patients to ensure proper coordination and reimbursement for healthcare services. Responsibilities include:

• 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.

Qualifications

• High School Diploma or Equivalent required; Associate's Degree in Related Field of Study preferred.
• Epic experience, as well as referral or authorization experience in a healthcare setting highly preferred.
• Previous experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing (2-3 years required).

Requirements

• 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.

Benefits

• Competitive base pay based on skills, relevant experience, education, certifications, and other essential factors.
• Comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate contributions and support professional growth.