Billing Managed Care Coordinator Lead

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

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 overseeing prior authorization and referral requests for medical services, including insurance eligibility verification, referrals for specialty care, medical necessity review, and compliance with payer, company, and HIPAA requirements. Reviews, compiles, submits, and documents all required medical records and authorization details in the EHR, maintaining accurate communication with payers and third‑party administrators. Leads and supports a team by collaborating across departments, precepting new hires, and conducting proactive and reactive audits to ensure timely processing, compliance, and continuous process improvement.

Does this position require Patient Care? No

Essential Functions: -Oversee daily operations of the prior authorization and referral department. Lead, mentor, and train team members, ensuring efficient workflow and adherence to policies and procedures. -Regularly review Epic and Tableau dashboards, including but not limited to work queue monitoring reports to forecast staffing needs. -Ensure compliance with payer requirements, healthcare regulations, and facility policies in all prior authorization activities, including tests and imaging, is collected, reviewed, and submitted accurately and promptly to insurance companies and other payers. -Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues. -Develop and implement process improvements to enhance efficiency and reduce authorization turnaround times. -Address and resolve complex authorization denials and appeals, working with providers, patients, and payers to achieve favorable outcomes. -When unclear, collaborates with ordering clinicians to ensure the proper CPT codes are submitted for prior authorization or referrals. -Refer patients to financial counseling, as appropriate.

Qualifications

• Education: High school diploma or equivalent is required.

• Preferred

Education

• Associate’s degree in related field.

• Experience in lieu of degree: No. Candidates must meet the minimum education requirement.

• Healthcare

Experience

• 3–5 years required in: Prior authorization medical billing or a related healthcare role,

• Leadership/Supervisory

Experience

• 1–2 years preferred.

• Epic

Experience

• 1–2 years required

• Knowledge, Skills and Abilities

• In-depth knowledge of prior authorization processes, payer requirements, and healthcare regulations.

• Strong leadership, management, and team-building skills.

• Excellent communication and interpersonal skills, with the ability to interact effectively with providers, patients, and insurance representatives.

• Proficiency in electronic health records (EHR) systems and prior authorization software.

• Strong analytical and problem-solving abilities, excellent attention to detail, and organizational skills.

• Ability to work in a fast-paced environment.

• Additional Job Details (if applicable)

• Department: BWH Radiology Referral and Prior Authorization Department

• Schedule: Monday - Friday | 7:30 am to 4pm| 100% remote, but candidate must reside in the United States.

• No visa sponsorship available. Candidate must be authorized to work in the U.S. without current or future sponsorship.

• Compensation: The posted salary reflects the starting range for this position. Actual compensation will be based on the selected candidate's qualifications, including experience, education, and relevant skills.

• Benefits: Medical, Dental, Vision, 403b retirement plan, tuition reimbursement, discounted MBTA pass & more!

• Remote Type

• Remote

• Work Location

• 1620 Tremont Street

• Scheduled Weekly Hours

• 40

• Employee Type

• Regular

• Work Shift

• Day (United States of America)

• Pay Range

• $25.50 - $36.49/Hourly

• Grade

• 5

• At 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.

• 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.