Insurance Eligibility Verification Jobs in Boston, MA

The Intake, Engagement & Billing Specialist plays a key role in supporting access to services across the agency’s Integrated Care Division as well as connect. This position manages referral and intake processes for multiple care coordination and community-based programs, ensuring individuals are connected efficiently and appropriately to services within the agency’s continuum of care or to external providers when needs fall outside of the agency’s scope. The Specialist is responsible for coordinating referral tracking, client outreach and engagement, insurance eligibility verification, prior authorization and reauthorization activities, and supporting billing-related functions. This role also participates in a centralized Intake & Engagement team and serves as a Certified Application Counselor (CAC) to support 
the agency’s health insurance counseling and enrollment efforts. Programs supported may include, but are not limited to: Community Support Program (CSP) Community Support Program – Homeless Individuals (CSP-HI) Community Support Program – Justice Involved (CSP-JI) Health-Related Social Needs (HRSN) Housing Supplemental Services One Care Health Home Restoration Center CBHC.

Intake & Referral Coordination: 
• Manages incoming referrals for Integrated Care Division programs through centralized referral systems and workflows. 
• Reviews referrals for completeness, eligibility, and appropriateness of services. 
• Coordinates intake and engagement activities to ensure timely connection to services. 
• Conducts outreach to referred individuals, providers, hospitals, community agencies, and other referral sources. 
• Maintains ongoing communication with referral sources regarding referral status and disposition. 
• Supports screening and triage processes to determine the most appropriate level of care or service. 
• Facilitates referrals to external providers and community resources when individuals’ needs fall outside of the agency’s scope of services. 

Client Engagement & Support: 
• Engages referred individuals using person-centered and trauma-informed approaches. 
• Assists individuals with navigating services, scheduling initial appointments, and overcoming barriers to engagement. 
• Documents outreach attempts, engagement activities, and referral outcomes in electronic health record and tracking systems. 
• Collaborates with program staff and leadership to support continuity of care and successful transitions into services. 
Insurance, Authorization & Billing Support: 
• Verifies insurance eligibility and benefits, including MassHealth, Medicare, One Care, and other coverage types. 
• Obtains and tracks prior authorizations and reauthorizations for assigned programs and services. 
• Monitors authorization timelines and ensure continuation requests are submitted timely to avoid service disruptions. 
• Supports billing readiness by ensuring required documentation and authorizations are in place. 
• Collaborates with billing, finance, and clinical teams to resolve authorization or claims-related issues. 

Health Insurance Counseling: 
• Maintains Certified Application Counselor (CAC) certification requirements. 
• Supports individuals with health insurance applications, renewals, troubleshooting, and navigation of MassHealth, Medicare, and other public insurance programs. 
• Provides education and assistance related to insurance eligibility, benefits, and enrollment processes. Collaborates with internal teams to support the agency’s centralized health insurance counseling function. 

Administrative & Quality Responsibilities: 
• Maintains accurate and timely documentation in all required systems. 
• Tracks referral, engagement, and authorization metrics as requested. 
• Participates in team meetings, trainings, and quality improvement initiatives. 
• Maintains knowledge of program eligibility requirements, payer requirements, and community resources. 
• Ensures compliance with agency policies, confidentiality standards, and regulatory requirements.

General:
Performs related duties as assigned.

Knowledge and Skills:
• Knowledge of community-based behavioral health, care coordination, and human service delivery systems 
• Understanding of MassHealth, Medicaid managed care, Medicare, and other public health insurance programs 
• Knowledge of insurance eligibility verification, authorization, reauthorization, and billing processes 
• Familiarity with Massachusetts behavioral health and social service systems, including CBHC, CSP, HRSN, and Health Home models 
• Understanding of person-centered, trauma-informed, and recovery-oriented approaches to service delivery 
• Knowledge of social determinants of health and barriers impacting access to care, housing, transportation, food security, and benefits 
• Familiarity with referral management, intake coordination, and client engagement practices 
• Knowledge of confidentiality requirements, HIPAA regulations, and documentation standards 
• Understanding of care coordination workflows and multidisciplinary team collaboration 
• Familiarity with electronic health records (EHRs), referral tracking systems, and data management practices 
• Knowledge of community resources and provider networks across behavioral health, medical, housing, and social service systems 
• Understanding of Certified Application Counselor (CAC) roles, responsibilities, and health insurance enrollment processes preferred Skills 
• Strong organizational and time management skills with the ability to manage multiple referrals, deadlines, and competing priorities 
• Excellent interpersonal and customer service skills with the ability to engage individuals from diverse backgrounds 
• Strong verbal and written communication skills 
• Ability to conduct outreach and engagement in a professional, compassionate, and persistent manner 
• Ability to triage referrals and determine appropriate service pathways based on individual needs and eligibility criteria 
• Strong attention to detail and accuracy in data entry, documentation, and billing-related activities 
• Ability to navigate insurance portals, authorization systems, and electronic health record platforms 
• Problem-solving and critical thinking skills with the ability to address barriers to care and resolve administrative issues 
• Ability to work collaboratively within a centralized intake team and across multidisciplinary programs 
• Ability to maintain confidentiality and exercise sound judgment in handling sensitive information 
• Proficiency in Microsoft Office Suite and other database or care management systems 
• Ability to analyze and track referral, authorization, and billing information for reporting and follow-up purposes 
• Ability to work independently while maintaining strong communication and coordination with team members 
• Cultural competency and ability to work effectively with individuals experiencing behavioral 
health, substance use, housing instability, and complex social needs.

Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,500 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in over 550 sites throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers.

My Job. My Community. My Vinfen.

Vinfen is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

Typical Requirements:
Minimum of 2 years of experience in healthcare, behavioral health, care coordination, intake, insurance navigation, billing support, or related human services setting.

Experience working with MassHealth, Medicare, One Care, or other public insurance programs.

Experience with prior authorizations, utilization management, or healthcare billing processes.

Ability to obtain and maintain Certified Application Counselor (CAC) certification.

Strong organizational skills with the ability to manage multiple priorities and timelines.

Excellent communication, customer service, and engagement skills.

Proficiency with electronic health records, Microsoft Office, and data tracking systems.

Ability to work collaboratively across multidisciplinary teams.
Preferred /Required Education:
High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.

Driving Requirements:
Driving is a requirement for this position using either a Vinfen van or personal vehicle. If using a personal vehicle, you must possess and maintain adequate insurance as well as maintain a safe driving record which is subject to annual checks. A valid driver's license must be presented at the time of employment. Incumbents must be at least 21 years of age, have maintained a valid US driver's license for at least six months, and must be able to pass a driver's screening background check. 

Physical Effort:
Ability to stand, walk, bend, kneel, stoop, crouch, crawl, climb as this is a very physically active position.

Must be able to lift at least 25 pounds using proper lifting techniques or the use of a two-person lift.

Ability to operate a computer and other office equipment such as a calculator, copier, and printer.

Ability to sit, reach, climb stairs, and maneuver through narrow spaces or hallways.

Ability to assist clients with tasks of daily living.

Ability to remain in a stationary position 50% of the time as needed.

Ability to bend, reach, file, sit, stand, and move around the facility.

Ability to speak, hear, and communicate with clients, staff, and external representatives.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth 
perception, and ability to adjust focus. 

Required Certifications/Trainings:
Certified Application Counselor Certificate

CPR within 2 weeks of hire

First Aid within 2 weeks of hire 
New Employee Training (NET)