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 cycleInitiate renewal process upon receipt of MassHealth notices; monitor deadlines and follow up on outstanding documentationFinancial 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 & ReportingMaintain tracking systems (spreadsheets or software) for MassHealth renewal timelines and outcomes

•     Support audits and internal reviews related to eligibilities and reimbursementGenerate 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 thinkingTime management skills

  Qualifications:

• Education & ExperienceAssociate’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 SkillsExperience 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 ExcelEffective communication skills with families and external agencies.Strong organizational and documentation skills 

  Remote Type:

  On-site

  Salary Range:

  $54,022.04 - $81,033.59