• Job Description

  Req#: 6060
  Overview
  
  The Benefits Specialist serves as a subject-matter expert on public health insurance and related benefits, with a primary focus on MassHealth (Medicaid) and Medicare. This role provides consultation, training, and direct support to staff across programs, ensuring individuals served maintain access to appropriate coverage and benefits.
  
  The Benefits Specialist leads complex case resolution, including appeals and high-risk escalations, and works collaboratively to minimize disruptions in care due to insurance issues. The Benefits Specialist promotes access to coverage and services in a way that respects each individual's goals, preferences, and lived experience.
  
  This role supports staff in removing barriers and advocating for equitable, timely access to care and benefits
  
  Responsibilities
  
  Subject-Matter Expertise
  • Serves as the agency's expert on MassHealth, Medicare, and other public benefits, including eligibility, enrollment, coverage rules, and coordination of benefits.
  • Interprets and communicates policy changes, regulatory updates, and system reforms impacting coverage and services.
  • Provides guidance on complex insurance scenarios, including dual eligibility, spend-downs, waivers, and managed care enrollment. Training and Capacity Building
  • Develops and delivers training to staff on insurance basics, eligibility processes, common barriers, and best practices.
  • Creates and maintains training materials, job aids, and resource guides tailored to program needs.
  • Provides ongoing coaching and technical assistance to staff to build confidence and competency in navigating benefits. Complex Case Consultation and Resolution
  • Supports staff in resolving complex insurance cases, including coverage denials, eligibility terminations, and access issues.
  • Supports staff with appeals processes, including gathering documentation, drafting appeal letters, and coordinating with providers and payers.
  • Troubleshoots high-risk cases where individuals are at risk of losing coverage or experiencing gaps in care.
  
  Escalation Management
  • Serves as the point of contact for high-risk escalations related to insurance and benefits.
  • Collaborates with internal leadership, external partners, and state agencies to resolve urgent or systemic issues.
  • Tracks and analyzes trends in escalations to identify opportunities for system improvements.
  
  Collaboration and Coordination
  • Partners with program leadership, care teams, and administrative staff to ensure coordinated approaches to benefits management.
  • Builds and maintains relationships with MassHealth, Medicare plans, Accountable Care Organizations (ACOs), One Care plans, and other stakeholders.
  • Participates in interdisciplinary team meetings as needed to support person-centered care planning. Documentation and Compliance
  • Ensures accurate documentation of benefits-related activities in accordance with agency and regulatory standards.
  • Maintains confidentiality and compliance with HIPAA and other applicable regulations.
  • Supports audits and reporting requirements related to insurance and benefits.
  
  General
  • Performs other duties as assigned.
  
  Knowledge and Skills:
  • Deep knowledge of MassHealth (Medicaid), Medicare, and dual-eligibility rules, including enrollment, eligibility, covered services, and coordination of benefits.
  • Understanding of Massachusetts-specific models such as One Care, ACOs, and other publicly funded health programs.
  • Expertise in navigating complex insurance scenarios, including eligibility disruptions, coverage denials, prior authorizations, and appeals processes.
  • Familiarity with public benefits beyond health insurance (e.g., SNAP, SSI/SSDI) and how they intersect with healthcare access.
  • Strong training and facilitation skills, with the ability to translate complex policy and regulatory information into clear, practical guidance for staff.
  • Advanced problem-solving and critical thinking skills, particularly in high-risk or time-sensitive situations. Ability to analyze trends, identify systemic barriers, and recommend process improvements.
  • Strong written communication skills, including drafting appeals, summaries, and guidance documents. Effective interpersonal skills and the ability to collaborate with multidisciplinary teams, external partners, and state agencies.
  • High level of organization and ability to manage multiple priorities, deadlines, and escalations simultaneously.
  • Proficiency with electronic health records and data systems, with strong attention to detail and documentation standards.
  • Commitment to person-centered, culturally responsive, and trauma-informed approaches to service delivery.
  
  About Vinfen
  
  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.
  
  Qualifications
  
  Typical Requirements:
  • Minimum of 3-5 years of experience working with MassHealth, Medicare, or other public benefits programs.
  • Demonstrated expertise in complex insurance navigation, including appeals and dual eligibility.
  
  Experience providing staff training and consultation preferred.
  • Strong analytical, problem-solving, and communication skills.
  • Ability to manage multiple priorities and respond effectively to urgent situations.
  
  Preferred /Required Education:
  Bachelor's degree in social work, public health, human services, or related field required; Master's degree preferred
  
  Driving Requirements:
  May be called on to drive for Vinfen using either a Vinfen van or personal vehicle. - 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 one year, and must be able to pass a driver's screening background check. If driving, must maintain a safe driving record, which is subject to annual checks. If using a personal vehicle, must possess and maintain adequate insurance.
  
  Physical Effort:
  Administrative/Direct Care Roles - 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. For positions in day programs or group residences, the ability to assist in routine living activities including cleaning, meal preparation, vacuuming, shoveling, and grocery shopping.
  
  Required Certifications/Trainings:
  CPR within 2 weeks of hire, First Aid within 2 weeks of hire, New Employee Training (NET)"]

• About the company

  The best remote jobs for you

Notice