HealthCare Authorization, Insurance Verification, & Medical Billing Specialist

Description

DAYS/HOURS: 40 hours, Monday–Friday, 8:00 a.m.–4:30 p.m.

Pays $50,000 $60,000K annually DOE  (Salary ranges provided are based on relevant experience and skill set) 

LOCATION:  444 Harrison Avenue, Boston, MA

This position is eligible for hybrid work in pursuant to Pine Street Inn’s Remote Working Policy. There may be occasions when in-office work is required such as audits, licensing visits, or other organizational needs.

The position is considered non-essential during weather or emergency events.

SUMMARY OF POSITION:

The HealthCare Authorization, Insurance Verification, and Medical Billing Specialist is responsible for supporting the full revenue cycle functions related to client eligibility, authorization acquisition, and medical billing. This includes securing insurance authorizations, verifying eligibility, performing detailed billing reviews, assisting with claims processing, documenting all activities, and coordinating closely with internal staff, payers, and managed care entities to ensure accurate and timely reimbursement.

Ensures all activities are performed in accordance with OIG compliance guidance, payer requirements, and internal controls designed to prevent fraud, waste, and abuse. Maintains accurate, complete, and timely documentation to support billing and reimbursement. Participates in audits, monitoring activities, and corrective action plans as required.

QUALIFICATIONS

EDUCATION/TRAINING

Required:

• High      School Diploma or GED

Preferred:

Bachelor’s degree or relevant education/training in third-party payer requirements, billing, or health administration

KNOWLEDGE/EXPERIENCE

Required:

• Minimum      of two (2) years of experience supporting medical billing and revenue      cycle functions, including eligibility, authorizations, and claims review
• Strong      planning and organizational skills; ability to work effectively with      managers, peers, and external partners
• Knowledge      of MassHealth Eligibility System, health insurance eligibility systems,      and coverage processes
• Knowledge      of Commercial and MassHealth coverage types, ACOs, and MCOs
• Experience      communicating with insurers to secure authorizations and resolve coverage      or billing issues
• Working      knowledge of the healthcare authorization process from initiation through      approval
• Ability      to confirm and update accurate insurance information within the EHR
• Experience      performing billing support functions, including reviewing client account      and claim detail for accuracy, completeness, and compliance
• Strong      computer skills, including proficiency with Excel or Microsoft Access for      data entry, analysis, and reporting

Preferred:

• Experience      with Electronic Health Records (CareLogic)
• Knowledge      of CSPECH, Stabilization, Recovery Coach, and other Behavioral Health      services
• Knowledge      of MassHealth Virtual Gateway
• Knowledge      of HIPAA and 42 CFR Part 2

Requirements

EDUCATION/TRAINING:

Required:

• High School Diploma or GED

Preferred: 

• Bachelor’s degree or relevant education/training in third-party payer requirements, billing, or health administration

KNOWLEDGE/EXPERIENCE:

Required:

• Minimum of two (2) years of experience supporting medical billing and revenue cycle functions, including eligibility, authorizations, and claims review
• Strong planning and organizational skills; ability to work effectively with managers, peers, and external partners
• Knowledge of MassHealth Eligibility System, health insurance eligibility systems, and coverage processes
• Knowledge of Commercial and MassHealth coverage types, ACOs, and MCOs
• Experience communicating with insurers to secure authorizations and resolve coverage or billing issues
• Working knowledge of the healthcare authorization process from initiation through approval
• Ability to confirm and update accurate insurance information within the EHR
• Experience performing billing support functions, including reviewing client account and claim detail for accuracy, completeness, and compliance
• Strong computer skills, including proficiency with Excel or Microsoft Access for data entry, analysis, and reporting

Preferred:

• Experience with Electronic Health Records (CareLogic)
• Knowledge of CSPECH, Stabilization, Recovery Coach, and other Behavioral Health services
• Knowledge of MassHealth Virtual Gateway
• Knowledge of HIPAA and 42 CFR Part 2