Senior Patient Financial Services Specialist

Job Description:

The Patient Financial Services Specialist is responsible for both long-term care and hospital settings. This role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs.

The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.

Position Responsibilities:

MassHealth (Medicaid) Eligibility & Maintenance

• Complete and submit MassHealth applications and renewals accurately and timely
• Assist patients, families and guarantors in gathering required financial documentation
• Resolve eligibility issues, denials, and coverage gaps
• Stay current with Massachusetts Medicaid regulations and policy changes
• Track and manage all resident MassHealth renewal dates on a rolling 12-month cycle
• Initiate renewal process upon receipt of MassHealth notices; monitor deadlines and follow up on outstanding documentation

Financial Coordination

• Verify insurance coverage and benefits across multiple payers in conjunction with admissions.
• Collect, review, and organize required financial documents (bank statements, income verification, asset records, social security records, etc.)
• Determine ability to pay privately vs. eligibility for assistance programs.
• Coordinate transitions between payers (e.g., Medicare to Medicaid; Private to Medicaid)
• Ensure accurate payer source assignment and billing readiness
• Coordinate with billing as needed.

Patient & Family Support

• Educate patients, families and guarantors on coverage options, financial responsibility, and eligibility requirements
• Provide guidance on spend-down requirements, asset documentation, patient paid amounts and compliance
• Serve as a point of contact for financial inquiries and concerns
• Help residents and family understand how to pay for care
• Make complex financial systems understandable
• Maintain accurate and up-to-date resident financial files.

Compliance & Documentation

• Maintain accurate, complete, and audit-ready financial records
• Ensure compliance with Federal and Massachusetts Medicaid regulations
• Support internal and external audits related to billing and eligibility
• Identify and escalate potential eligibility issues for MassHealth (excess assets, missing documentation, etc.)

Accounts Receivable

• Follow up on unpaid claims, resolve discrepancies, and ensure timely payments.
• Monitor and track accounts receivable, ensuring all payments are received timely
• Work with residents, families, and external agencies to resolve any billing issues or payment delays.

Systems & Reporting

• Maintain tracking systems (spreadsheets or software) for MassHealth renewal timelines and outcomes
• Support audits and internal reviews related to eligibilities and reimbursement
• Generate reports on upcoming MassHealth renewals, MassHealth Pending and submission statuses, etc.

Collaboration

• Communicate with state agencies, managed care organizations, and third-party payers
• Communicate MassHealth renewal requirements, deadlines, and status updates clearly and professionally
• Participate in interdisciplinary care and discharge planning as needed
• Provide financial insight that impacts discharge planning or long-term placement.
• Coordination with interdisciplinary teams (admissions, social workers, clinical, billing, etc.)

Core Competencies:

• Analytical thinking and problem-solving
• Regulatory and policy expertise
• Compassionate patient interaction
• Organizational and time management skills
• Adaptability in a complex reimbursement environment
• Problem solving and critical thinking
• Time management skills

Qualifications:

Education & Experience

• Associate's or Bachelor's degree in Healthcare Administration, Finance, or related field (preferred)
• 2-5+ years of experience in:

Patient financial services, case management, or healthcare billing

Massachusetts Medicaid (MassHealth) eligibility and applications

Long-term care and hospital reimbursement

• Experience with financial document review and case management preferred

Required Knowledge & Skills:

Deep understanding of:

MassHealth application and renewal processes

Long-term care (custodial) reimbursement structures

SNF reimbursement (including Medicare Part A and Medicaid coordination)

Managed care reimbursement models and authorization requirements

Medicaid eligibility rules (income/assets, 5-year lookback)

• Strong knowledge of insurance verification and billing workflows
• Excellent attention to detail and documentation accuracy
• Ability to manage multiple cases and deadlines simultaneously
• Strong communication and interpersonal skills

Preferred Skills

• Experience with electronic medical records (EMR) and billing systems
• Familiarity with Massachusetts long-term care regulations and compliance standards
• Meditech experience desirable. Other nursing home software experience will be considered
• Proficiency in Microsoft Excel
• Effective communication skills with families and external agencies.
• Strong organizational and documentation skills

Remote Type:

On-site

Salary Range:

$54,022.04 - $81,033.59