Remote Health Services Coordinator - Utilization & Support

8510 Health New England, Inc.; United States; Hybrid; USD 32,000 - 44,000; Full time

Job summary

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

Qualifications

• 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.

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.

Skills

Strong communication

Typing accuracy

Organizational skills

Prioritization

Independent work

Team collaboration

Multicultural awareness

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Job description

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