Senior Patient Financial Services Specialist

Patient Financial Services Specialist

The Patient Financial Services Specialist is responsible for both long-term care and hospital settings. This role requires specialized expertise in Massachusetts Medicaid (Mass Health), 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, Mass Health and payers to ensure timely coverage, guarantor education, and financial compliance.

Mass Health (Medicaid) Eligibility & Maintenance

• Complete and submit Mass Health 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 Mass Health renewal dates on a rolling 12-month cycle
• Initiate renewal process upon receipt of Mass Health 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 Mass Health (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 Mass Health renewal timelines and outcomes
• Support audits and internal reviews related to eligibilities and reimbursement
• Generate reports on upcoming Mass Health renewals, Mass Health Pending and submission statuses, etc.

Collaboration

• Communicate with state agencies, managed care organizations, and third-party payers
• Communicate Mass Health 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.)

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

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 (Mass Health) eligibility and applications Long-term care and hospital reimbursement Experience with…