Health Services Coordinator

8510 Health New England, Inc.; United States; Hybrid; USD 32.000 - 44.000; Vollzeit

Zusammenfassung

Baystate Health’s Health New England (HNE) is seeking a detail-oriented Health Services Coordinator to join our Utilization Management team in Springfield, MA. This role involves coordinating service requests, supporting providers and members, maintaining accurate documentation, and assisting with appeals, claims, and education of members about benefits and programs.

The position offers a full-time schedule with some remote work opportunities for residents in MA/CT, and requires a high school

Qualifikationen

• High school diploma required.
• At least 2 years of experience in a medical administrative role.
• Knowledge of medical terminology or related training.
• Beginner to intermediate proficiency with Microsoft Word and Excel.

Aufgaben

• Coordinate Service Requests: Review and process authorizations based on member benefits, established criteria, and applicable guidelines.
• Support Providers and Members: Serve as a primary contact for Health Services-related inquiries, providing clear information about benefits, eligibility, procedures, and authorization decisions.
• Maintain Accurate Documentation: Complete authorization entry, generate correspondence, audit benefit information, and meet productivity and turnaround-time standards.
• Partner with Case Managers: Assist with research, troubleshooting, correspondence, and administrative support related to member service requests.
• Support Internal Departments: Provide education and assistance to Member Services, Provider Relations, Sales, and other HNE teams, helping resolve complex issues and coordinate member care.
• Assist with Appeals and Claims: Support the member appeals process, research claims questions, and help resolve benefit-related concerns.
• Educate Members and Providers: Explain criteria-based procedures, provide benefit information, and conduct outreach to connect members with available programs and resources.
• Support Medicare and Other Programs: Assist with Medicare Advantage Health Risk Assessment data, government program requirements, and applicable CMS guidelines.
• Protect Member Confidentiality: Follow HNE policies and all applicable HIPAA, DOI, NCQA, and regulatory standards.

Kenntnisse

Strong communication

Typing accuracy

Organizational skills

Prioritization

Independent work

Team collaboration

Multicultural awareness

Ausbildung

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Jobbeschreibung

Baystate Health’s Health New England (HNE) is seeking a detail-oriented and service-focused Health Services Coordinator to join our Utilization Management team in Springfield, MA

Responsibilities

• Coordinate Service Requests: Review and process authorizations based on member benefits, established criteria, and applicable guidelines.
• Support Providers and Members: Serve as a primary contact for Health Services-related inquiries, providing clear information about benefits, eligibility, procedures, and authorization decisions.
• Maintain Accurate Documentation: Complete authorization entry, generate correspondence, audit benefit information, and meet productivity and turnaround-time standards.
• Partner with Case Managers: Assist with research, troubleshooting, correspondence, and administrative support related to member service requests.
• Support Internal Departments: Provide education and assistance to Member Services, Provider Relations, Sales, and other HNE teams, helping resolve complex issues and coordinate member care.
• Assist with Appeals and Claims: Support the member appeals process, research claims questions, and help resolve benefit-related concerns.
• Educate Members and Providers: Explain criteria-based procedures, provide benefit information, and conduct outreach to connect members with available programs and resources.
• Support Medicare and Other Programs: Assist with Medicare Advantage Health Risk Assessment data, government program requirements, and applicable CMS guidelines.
• Protect Member Confidentiality: Follow HNE policies and all applicable HIPAA, DOI, NCQA, and regulatory standards.

Schedule

Full-time, 40 hours a week Monday through Friday Rotating weekends Training schedule will 8:00am-4:30pm, following training – schedule will be 8:30am-5:00pm

Location

1 Monarch Place Springfield, MA Remote work opportunity – Candidate must live in MA or CT as occasional in on‑site meeting is required.

Qualifications

• High school diploma or equivalent, required.
• At least 2 years of experience in a medical administrative role within a physician's office, clinic, medical facility, or the insurance industry, required.
• Knowledge of medical terminology or related training.
• Beginner to intermediate proficiency with Microsoft Word and Excel.
• Strong typing accuracy and attention to detail.
• Excellent problem-solving, organizational, and prioritization skills.
• Strong listening and communication skills, both over the phone and in person.
• Ability to work independently and collaboratively in a team environment.
• Ability to interact effectively with a diverse, multicultural membership.
• Education: High School Diploma (Required)
• Certifications: Compensation

Pay

Minimum - Midpoint - Maximum $23.46 - $26.97 - $31.91

Equal Employment Opportunity

Equal Employment Opportunity Employer Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

About Baystate Health

Baystate Health is a not-for-profit, integrated healthcare system with hospitals, physician practices, a health plan and more serving over 800,000 people throughout western New England. Baystate Health is the safety net provider in Western Massachusetts. With roots dating to the founding of Springfield Hospital in 1883, Baystate Health has been providing high-quality, compassionate and accessible care in the Pioneer Valley for more than 140 years and continues to be a pillar of its community - rooted here, serving here, and helping generations thrive here. With a focus on advancing health for all, Baystate is not only a keystone of the region, it is a national leader in health care. Learn more at BaystateHealth.Org The ever-growing health system includes six Massachusetts hospitals: Baystate Medical Center in Springfield Baystate Children’s Hospital (located at Baystate Medical Center) Baystate Franklin Medical Center in Greenfield Baystate Wing Hospital in Palmer Baystate Noble Hospital in Westfield Baystate Mercy Hospital in Springfield