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Job description
Senior Patient Financial Services SpecialistThe 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:MassHealth (Medicaid) Eligibility & MaintenanceComplete and submit MassHealth applications and renewals accurately and timelyAssist patients, families and guarantors in gathering required financial documentationResolve eligibility issues, denials, and coverage gapsStay current with Massachusetts Medicaid regulations and policy changesTrack and manage all resident MassHealth renewal dates on a rolling 12-month cycleInitiate renewal process upon receipt of MassHealth notices; monitor deadlines and follow up on outstanding documentationFinancial CoordinationVerify 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 readinessCoordinate with billing as needed.Patient & Family SupportEducate patients, families and guarantors on coverage options, financial responsibility, and eligibility requirementsProvide guidance on spend-down requirements, asset documentation, patient paid amounts and complianceServe as a point of contact for financial inquiries and concernsHelp residents and family understand how to pay for careMake complex financial systems understandableMaintain accurate and up-to-date resident financial files.Compliance & DocumentationMaintain accurate, complete, and audit-ready financial recordsEnsure compliance with Federal and Massachusetts Medicaid regulationsSupport internal and external audits related to billing and eligibilityIdentify and escalate potential eligibility issues for MassHealth (excess assets, missing documentation, etc.)Accounts ReceivableFollow up on unpaid claims, resolve discrepancies, and ensure timely payments.Monitor and track accounts receivable, ensuring all payments are received timelyWork with residents, families, and external agencies to resolve any billing issues or payment delays.Systems & ReportingMaintain tracking systems (spreadsheets or software) for MassHealth renewal timelines and outcomesSupport audits and internal reviews related to eligibilities and reimbursementGenerate reports on upcoming MassHealth renewals, MassHealth Pending and submission statuses, etc.CollaborationCommunicate with state agencies, managed care organizations, and third-party payersCommunicate MassHealth renewal requirements, deadlines, and status updates clearly and professionallyParticipate in interdisciplinary care and discharge planning as neededProvide 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-solvingRegulatory and policy expertiseCompassionate patient interactionOrganizational and time management skillsAdaptability in a complex reimbursement environmentProblem solving and critical thinkingTime management skillsQualifications:Education & ExperienceAssociate'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 billingMassachusetts Medicaid (MassHealth) eligibility and applicationsLong-term care and hospital reimbursementExperience with financial document review and case management preferredRequired Knowledge & SkillsDeep understanding of:MassHealth application and renewal processesLong-term care (custodial) reimbursement structuresSNF reimbursement (including Medicare Part A and Medicaid coordination)Managed care reimbursement models and authorization requirementsMedicaid eligibility rules (income/assets, 5-year lookback)Strong knowledge of insurance verification and billing workflowsExcellent attention to detail and documentation accuracyAbility to manage multiple cases and deadlines simultaneouslyStrong communication and interpersonal skillsPreferred SkillsExperience with electronic medical records (EMR) and billing systemsFamiliarity with Massachusetts long-term care regulations and compliance standardsMeditech experience desirable. Other nursing home software experience will be consideredProficiency in Microsoft ExcelEffective communication skills with families and external agencies.Strong organizational and documentation skillsRemote Type:HybridSalary Range:$54,022.04 - $81,033.59
Worksite address
roslindale, MA, 02131, US
Who can apply
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