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