Senior Patient Financial Services Specialist

About this role

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

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