Senior Patient Financial Services Specialist

Requirements

• 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

Benefits

Additional Information

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

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at hebrewseniorlife? Share your experience