Medicaid Billing Specialist Remote

OPCO Skilled Management; Albuquerque (NM); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

OPCO Skilled Management seeks a Medicaid Advocate to review Medicaid pending applications and renewals for assigned facilities, ensuring eligibility for timely coverage and approvals.

Provides ongoing support to Regional AR staff, BOM and ABOM in billing, claims, eligibility, and authorization for Medicaid, Medicare, and Managed Care across payer types.

Qualifications

• Experience in Medicaid application/renewal for LTC facilities.
• Familiarity with TMHP and SimpleLTC portals preferred.
• Proficient in computer use and data entry with attention to detail.

Responsibilities

• Review referrals and Medicaid questionnaires to determine eligibility.
• Submit applications with supporting documentation to HHSC.
• Communicate with residents/families about documentation needs.
• Maintain tracking for Medicaid Pending residents and renewals.
• Email facility and Regional BO Consultant for information.
• Attend biweekly calls to discuss statuses and denials.
• Assist training of Business Office staff on Medicaid application.
• Report delays or denials to Senior Medicaid Advocate.
• Ensure compliance with State laws and Organization policies.
• Support other Central Billing Office departments as needed.

Skills

Medicaid application experience

Medicaid LTC facilities experience

Proficient computer skills

Well organized

Multitasking

Attention to detail

Travel with license

Tools

TMHP portal

SimpleLTC portals

Job description

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.

Job Type & Benefits Offered

Job Type: Full-Time.

• Healthcare
• Dental
• Vision
• PTO
• 401K

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

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.