Healthcare Authorization, Insurance Verification, & Medical Billing Specialist

Pine Street InnBoston, MA

$48,000 - $60,000 / year

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Overview

Schedule

Full-time

Career level

Entry-level

Remote

Hybrid remote

Compensation

$48,000-$60,000/year

Job Description

Description

SCHEDULE: 40 hours, Monday-Friday, 8:00 a.m.-4:30 p.m.

Pays $48,000 - $60,0000 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.

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

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FAQs About Healthcare Authorization, Insurance Verification, & Medical Billing Specialist Jobs at Pine Street Inn

What is the work location for this position at Pine Street Inn?

This job at Pine Street Inn is located in Boston, MA, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.

What pay range can candidates expect for this role at Pine Street Inn?

Candidates can expect a pay range of $48,000 and $60,000 per year.

What employment applies to this position at Pine Street Inn?

Pine Street Inn lists this role as a Full-time position.

What experience level is required for this role at Pine Street Inn?

Pine Street Inn is looking for a candidate with "Entry-level" experience level.

What is the process to apply for this position at Pine Street Inn?

You can apply for this role at Pine Street Inn either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.