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Eligibility/Billing Specialist

Location : Holyoke, MA
Job Type : Direct
Hours : Full Time
Travel : No
Relocation : No

Job Description :

Position Summary:

  • Responsible for claims oversight and partner payments.

  • Responsible for performing daily MassHealth eligibility checks. This including reporting the type of coverage, health plan enrollment and CP assignment for all MassHealth programs in the agency. Interface with various programs, finance and quality teams as necessary.


Essential Duties and Responsibilities:

  1. Verifies MassHealth eligibility for the Personal Care Management, Home Care, Adult Family Care, SCO, Nutrition and LTSS CP programs according to program regulations.

  2. Enters changes to or loss of eligibility in PCM database. Reports member changes to the appropriate departments.

  3. Reviews and responds to retroactive eligibility verification requests from the Billing Supervisor and program staff.

  4. Maintains eligibility audit files.

  5. Completes and processes billing as assigned according to program regulations, policies and procedures.

  6. Responsible for the creation of  partner payment report signed off by the Community Resources Director and Director of Finance.

  7. Responsible for program accounting including partner payment, receivables, expenses and adjustments.

  8. Works with the Quality and Community Resource teams on related projects.

  9. Prepares reports and performs administrative tasks as needed and requested by the Director of Finance.


Required Qualifications :

Knowledge, Skills and Abilities Required:

  • Possesses the ability and willingness to support the goals and policies of the client; and has the ability to interpret, understand and adhere to the regulations, standards and procedures as set forth.

  • Associates degree in Business, Accounting or related field.

  • Previous experience in Accounting or Business Management.

  • Excellent computer skills working with MSWord, MSExcel and various databases.

  • Must possess strong organization, communication and interpersonal skills

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