Senior Patient Financial Services Specialist

Position Responsibilities

• Complete and submit MassHealth applications and renewals accurately and timely
• Aid 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
• 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
• Cookordinate transitions between payers (e.g., Medicare to Medicaid; Private to Medicaid)
• Ensure accurate payer source assignment and billing readiness
• Cookordinate with billing as needed
• 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
• 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
• Cookordinate with interdisciplinary teams (admissions, social workers, clinical, billing, etc.)

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; 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