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

RESPONSIBILITES

The Health Services Coordinator serves as a key resource for members, providers, and internal teams, helping coordinate service requests, communicate benefit and authorization decisions, and support access to appropriate healthcare services. You'll work closely with Case Managers and departments across HNE to research issues, provide education, and help members navigate their healthcare benefits.

Key Responsibilities include:

• 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:

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

Equal Employment Opportunity Employer