Medicaid Eligibility & Billing Specialist

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

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.