Medicaid Eligibility & Billing Specialist

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

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.