Senior Patient Financial Services Specialist Per Diem

Job Description:

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:
• Key Responsibilities:
• MassHealth (Medicaid) Eligibility & MaintenanceComplete 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 CoordinationVerify 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 SupportEducate 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 careMake complex financial systems understandable 
•     Maintain accurate and up-to-date resident financial files.
• Compliance & DocumentationMaintain 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 ReceivableFollow up on unpaid claims, resolve discrepancies, and ensure timely payments.
•     Monitor and track accounts receivable, ensuring all payments are received timelyWork 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.
• CollaborationCommunicate with state agencies, managed care organizations, and third-party payers 
•     Communicate MassHealth renewal requirements, deadlines, and status updates clearly and professionallyParticipate 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:

   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 & ExperienceAssociate’s or Bachelor’s degree in Healthcare Administration, Finance, or related field (preferred) 
•     2–5+ years of experience in: 
• o    
• Patient financial services, case management, or healthcare billing 
• o    
• Massachusetts Medicaid (MassHealth) eligibility and applications 
• o    
• Long-term care and hospital reimbursement 
•     Experience with financial document review and case management preferred
• Required Knowledge & SkillsDeep understanding of: 
• o    
• MassHealth application and renewal processes 
• o    
• Long-term care (custodial) reimbursement structures 
• o    
• SNF reimbursement (including Medicare Part A and Medicaid coordination) 
• o    
• Managed care reimbursement models and authorization requirements 
• o    
• 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:

  Hybrid

  Salary Range:

  $54,022.04 - $81,033.59