Medicaid Eligibility & Billing Specialist

OPCO Skilled Management; Albuquerque (NM); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

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

You will support Regional AR staff, BOM and ABOM in billing, claims, eligibility and authorization across Medicaid, Medicare and Managed Care, with strong organization and attention to detail.

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, which includes a valid driver's license and automobile insurance.

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.

Skills

Proficient computer skills

Well organized

Multitasking

Attention to detail

Ability to travel

Tools

TMHP portals

SimpleLTC portals

Job description

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

You will support Regional AR staff, BOM and ABOM in billing, claims, eligibility and authorization across Medicaid, Medicare and Managed Care, with strong organization and attention to detail.