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
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
Remote Type:
On-site
Salary Range:
$54,022.04 - $81,033.59
