Senior Patient Financial Services Specialist Per Diem

Senior Patient Financial Services Specialist

The Senior 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)
  • 25+ years of experience in:
    • Patient financial services, case management, or healthcare billing
    • Massachusetts Medicaid (MassHealth) eligibility and applications
    • Long-term care and hospital reimbursement
• 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:

Hybrid

Salary Range:

$54,022.04 - $81,033.59