Medicaid Billing Specialist Remote

Opco-Skilled-Management-; Albuquerque (NM); Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

Opco-Skilled-Management- is seeking a Medicaid Advocate to review Medicaid Pending applications and renewals for assigned LTC facilities to ensure eligibility and timely coverage. You will support Regional AR staff, BOM and ABOM in billing, claims, eligibility and authorization processes across payers.

The role requires experience with Medicaid applications/renewals, familiarity with TMHP and SimpleLTC portals, strong organization and communication skills, and willingness to travel as needed.

Qualifications

• Experience reviewing Medicaid applications and renewals in LTC facilities.
• Familiarity with TMHP and SimpleLTC portals preferred.
• Proficient with standard office software.
• Strong organizational and multitasking abilities.
• Detail-oriented with ability to travel (driver’s license required).

Responsibilities

• Review referrals and Medicaid questionnaires to determine eligibility.
• Review applications and documentation before submission to HHSC.
• Communicate with residents or families about documentation needed.
• Maintain tracking for Medicaid Pending residents and renewals.
• Attend biweekly calls with facilities and Regional Business Office Consultant to discuss statuses.
• Train Business Office staff on Medicaid processes.
• Report delays or denials to Senior Medicaid Advocate.
• Ensure compliance with state laws and the Organization’s Compliance Plan.

Skills

Medicaid experience

TMHP portal experience

Computer skills

Organization & multitasking

Attention to detail

Travel ability

Tools

TMHP Portal

SimpleLTC Portal

Job description

Job Type: Full-Time.

Benefits Offered:

• Healthcare
• Dental
• Vision
• PTO
• 401K

Your Job Summary

The Medicaide Advoctage will be responsible for reviewing the Medicaid Pending applications and Medicaid renewals for assigned facilities to ensure Medicaid eligibility to obtain timely coverage and approvals. Provides ongoing support to Regional AR staff, BOM and ABOM in the areas of billing, claims, eligibility and authorization process for all payer types, such as Medicaid, Medicare, Managed Care, etc.

Your Qualifications

• Experience in the application/renewal process for Medicaid in LTC facilities
• Experience with TMHP and SimpleLTC portals preferred
• Proficient computer skills
• Well organized and able to multitask
• Attention to detail
• Ability to travel, which includes a valid driver’s license and automobile insurance

Your Responsibilities

Principal Responsibilities

• Review referrals and Medicaid questionnaire from assigned facilities to determine eligibility for Medicaid.
• Review all applications and supporting documentation prior to submitting to HHSC.
• May have communication with the residents and/or family members regarding the application process and supporting documentation needed.
• Maintain tracking system for all assigned Medicaid Pending residents to approval.
• Maintain tracking system to monitor Medicaid renewals to avoid interruption in coverage.
• Email communication with the facility and Regional Business Office Consultant to obtain information needed for the application process or renewal.
• Attend biweekly calls with assigned facilities and Regional Business Office Consultant for assigned facilities to discuss statuses, approvals, denials and any information needed from the facility.
• May assist with training the Business Office staff on the Medicaid application process.
• Report any delays, barriers or denials to the Senior Medicaid Advocate.
• Report weekly to the Senior Medicaid Advocate any outstanding items needed for application/renewal completion as well as the status on any denials.
• Ensure compliance with all State laws in relation to your position.
• Adherence to the Organization’s Compliance Plan and Code of Ethics.
• May occasionally assist other departments within the Central Billing Office.
• Other duties, responsibilities and activities may change or assigned at any time with or without notice.