Intake Engagement & Billing Specialist MA IC

Overview

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.

Responsibilities

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 manage