Medicaid Billing Specialist Remote

OPCO Skilled Management; Albuquerque (NM); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

OPCO Skilled Management in Albuquerque, NM is seeking a Medicaid Advocate to review Medicaid Pending applications and renewals for facilities, ensuring eligibility and timely coverage.

You will support Regional AR staff, BOM and ABOM in billing, claims, eligibility and authorization across payer types; travel as needed.

This full-time role requires attention to detail and strong organizational skills, with opportunities to train staff and improve processes.

Qualifications

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

Responsibilities

• Review referrals and Medicaid questionnaires from assigned facilities to determine eligibility for Medicaid.
• Review all applications and supporting documentation prior to submission to HHSC.
• Communicate with residents and/or family members regarding the application process and supporting documentation.
• Maintain tracking system for all Medicaid Pending residents to approval.
• Monitor Medicaid renewals to avoid interruption in coverage.
• Email communication with facilities and Regional Business Office Consultant for information needed.
• Attend biweekly calls with facilities and Regional Business Office Consultant to discuss statuses and approvals.
• May assist in training Business Office staff on Medicaid application process.
• Report delays, barriers or denials to Senior Medicaid Advocate.
• Report weekly on outstanding items and denials status.
• Ensure compliance with State laws and Organization’s Compliance Plan and Code of Ethics.
• May assist other departments within Central Billing Office.

Skills

Medicaid experience

TMHP

SimpleLTC portals

Proficient computer skills

Organized

Attention to detail

Travel ability

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.