Senior Patient Financial Services Specialist Per Diem

Job description

Job Description: The Senior 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: Key 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: 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: o Patient financial services, case management, or healthcare billing o Massachusetts Medicaid (MassHealth) eligibility and applications o Long-term care and hospital reimbursement • Experience with financial document review and case management preferred Required Knowledge & Skills • Deep understanding of: o MassHealth application and renewal processes o Long-term care (custodial) reimbursement structures o SNF reimbursement (including Medicare Part A and Medicaid coordination) o Managed care reimbursement models and authorization requirements o 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: Hybrid Salary Range: $54,022.04 - $81,033.59