Managed Care Services Rep
Share
Job Location:
Somerville, NJ - USA
Hourly Salary:
$ 19 - 28
Posted on:
10 hours ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
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.Essential Functions
-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
Education
High School Diploma or Equivalent required and Associates 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.
Additional Job Details (if applicable)
M-F 8:30 am-5:00 pm EST schedule required for remote role
Quiet secure stable compliant work station required
Remote Type
Work Location
Pay Range
$19.81 - $28.30/HourlyGrade
3EEO Statement:
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.
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
