Senior Patient Financial Services Specialist Per Diem

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
Associates or Bachelors degree in Healthcare Administration Finance or related field (preferred)
25 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:

Salary Range: