Medicaid Billing Specialist - Precision Claims & Denials

Groundworks New Mexico; Albuquerque (NM); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Adelante is seeking a Medicaid Billing Specialist to ensure accurate submission of claims and compliance with NM Medicaid regulations. The role emphasizes accuracy, problem-solving, and care for underserved populations.

Key duties include verifying eligibility, coding, and supporting documentation, resolving denied claims, and maintaining HIPAA compliance. A related degree and Medicaid billing experience are preferred.

Qualifications

• High School Diploma or GED required.
• Associate degree in Accounting, Healthcare Administration, Business, or related field preferred.
• 1–3 years of Medical/Medicaid billing experience preferred.
• Experience billing New Mexico Medicaid and Medicaid managed care strongly preferred.
• Working knowledge of medical reimbursement processes and claim follow-up.

Responsibilities

• Prepare and submit Medicaid claims accurately and on time while following federal, state, and payer guidelines.
• Verify billing information, including client eligibility, authorizations, coding, and supporting documentation.
• Monitor and resolve denied or unpaid claims by researching issues, making corrections, and resubmitting claims when needed.
• Maintain compliance with New Mexico Medicaid regulations, HIPAA requirements, and billing policies.

Skills

Attention to accuracy

Problem solving

Billing verification

Denied claims resolution

HIPAA compliance

Education

High School Diploma or GED

Associate degree preferred

Tools

Medicaid billing software

Healthcare billing systems

Job description

Adelante is seeking a Medicaid Billing Specialist to ensure accurate submission of claims and compliance with NM Medicaid regulations. The role emphasizes accuracy, problem-solving, and care for underserved populations.

Key duties include verifying eligibility, coding, and supporting documentation, resolving denied claims, and maintaining HIPAA compliance. A related degree and Medicaid billing experience are preferred.