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Eligibility/Billing Specialist

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

Job Description :

We are looking for people with strong organization and teamworking skills to begin their career in a community-based healthcare organization. If you have accounting or business experience, this Direct Hire position in Holyoke could be a great fit for you!

Responsibilities Include:

  • 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.

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

  • Entering changes to or loss of eligibility in PCM database. Reports member changes to the appropriate departments.

  • Reviewing and responding to retroactive eligibility verification requests from the Billing Supervisor and program staff.

  • Maintaining eligibility audit files.

  • Completing and processing billing as assigned according to program regulations, policies and procedures.

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

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

  • Working with the Quality and Community Resource teams on related projects.

  • Preparing reports and performing administrative tasks as needed and requested by the Director of Finance. 


Required Qualifications :

  • Associates degree in Business, Accounting or related field.

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

  • Previous experience in Accounting or Business Management.

  • Excellent computer skills working with MS Word, MS Excel and other databases.

  • Must possess strong organization, communication and interpersonal skills

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