• Eligibility Specialist

    Job Locations US-MA-Framingham
    Minimum Education Required
    Associate's Degree
    Job ID
    Regular Full-Time
  • Overview

    The Eligibility Specialist is responsible for managing MassHealth Behavioral Health assignment files, checking eligibility and problem-solving claims issues. 


    Be part of the rapidly changing health care system!


    The Behavioral Health Partners of MetroWest (BHPMW) provides collaborative care coordination and wellness goal support to individuals with behavioral health and/or substance use needs, based on the recent transformation of Mass Health’s service delivery model.  The partnership is built on a collaboration among five community-based provider agencies: Advocates, Family Continuity, South Middlesex Opportunity Council (SMOC), Spectrum Health Systems, and Wayside Youth and Family Support Network, throughout MetroWest, Central and Northern Massachusetts. 

    Minimum Education Required

    Associate's Degree


    • Maintain a working knowledge of and adhere to MassHealth regulations.
    • Manage MassHealth Community Partners' assignment files, enrollment files and refresh files.  Ensure that all information is updated as needed.
    • Check eligibility on an ongoing and as needed basis, collaborating with Care Navigator and the Billing Specialist as indicated.
    • Problem solve claims issues in collaboration with the Billing Specialist.
    • Act as liaison between the billing specialist and claims issues and the BHPMW Consortium Entities and Affiliated Partner.
    • Help resolve claims issues by gathering, verifying and providing additional information as required and following up until reimbursements are received.
    • Develop a process for effectively identifying issues and communicate resolution of issues with all involved.
    • Identify and help problem solve when member loses eligibility.


    • Associate's Degree required.
    • Excellent written and verbal communication.
    • Strong computer skills, including working knowledge of Microsoft Excel.
    • Strong organizational skills, including the ability to multi-task.
    • Must hold a valid driver's license, have access to an operational and insured vehicle and be willing to use it to transport clients.
    • Strongly prefer a candidate that will have a demonstrated understanding of and competence in serving culturally diverse populations.


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