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