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Overview

*$22/Hr.

The Eligibility Referral Specialist is responsible for managing eligibility and authorization for people receiving services though Advocates Community Counseling (ACC) and Child Behavioral Health Services (CBHI).

Advocates promotes a healthy work-life balance and offers many generous perks of employment and room for advancement. We are a strong-knit community that values the ideas and contributions from our staff.

Are you ready to make a difference

Minimum Education Required

Associate's Degree

Shift

First Shift

Additional Shift Details

40 hours Tuesday to Friday 10-6, Saturday 9-5

Responsibilities

+ Check eligibility for ACC and CBHI members on a daily basis, collaborating with Clinic Staff and the Billing Specialists as indicated.

+ Responsible for learning and understanding eligibility requirements and allowed services for contracted Managed Care Entities.

+ Work closely with persons served and insurance providers to gather and verify insurance information.

+ Call or email insurance representatives to verify patient coverage and enrollment information, check to make sure that procedures are covered by the patient’s insurance, and verify copay amounts and billing information that the office sends to the insurance company for reimbursement.

+ Identify, notify staff and help problem solve when member loses eligibility.

+ Understand and monitor authorizations for ACC and CBHI.

+ Complete authorization requests and renewals as needed.

+ Problem solve claims issues in collaboration with the Billing Specialist.

+ Act as liaison between the billing specialist and clinic staff regarding eligibility and authorizations.

+ Help resolve eligibility and authorization issues issues by gathering, verifying and providing additional information as required and following up until issues are resolved.

+ Develop a process for effectively identifying issues and communicate resolution of issues with all involved.

Qualifications

+ Associate's degree or higher.

+ Excellent spreadsheet (Excel) and PC skills.

+ Strongly prefer that a candidate will have a demonstrated understanding of and competence in serving culturally diverse populations

+ Must be able to perform each essential duty satisfactorily.

+ Ability to communicate articulately and knowledgeably with all levels of internal staff and outside parties as required.

+ High energy level, superior interpersonal skills and ability to function in a team environment.

_Advocates is committed to cultivating a diverse and welcoming community where everyone feels respected and valued. Advocates fosters a culture of inclusion that celebrates and promotes diversity along multiple dimensions, including race, ethnicity, sex, gender identity, gender expression, sexual orientation, partnered status, age, national origin, socioeconomic status, religion, ability, culture, and experience._

Why Should I Consider a Career in Human Services?

Our Team members are dedicated to engaging and empowering individuals by forming lasting relationships, collaboratively achieving personal goals, offering creative solutions to everyday and complex situations, and _actively listening_ . We exercise independent judgement and contribute to the overall success and benefit of the Team.

Is Human Services a Fit for Me?

Successful Team members are open-minded, eager and compassionate, and will exercise solid, independent judgement while fostering trustworthy relationships with the individuals that we serve. We put the individual first.

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**Job Locations** _US-MA-Framingham_

**Minimum Education Required** _Associate's Degree_

**Job ID** _2025-12262_

**Organization** _Advocates_

**Type** _Regular Full-Time_

**Number of Hours Per Week** _40_

**Business Unit** _Behavioral Health_