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 escalation 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 #J-18808-Ljbffr Jobtailor