Medicaid Eligibility & Billing Specialist

Opco-Skilled-Management-; Albuquerque (NM); Remote; USD 52,000 - 70,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

Opco-Skilled-Management- seeks a Medicaid Advocate to oversee Medicaid eligibility reviews and renewals for assigned facilities, ensuring timely coverage across payer types. You will support Regional AR staff, BOM, and ABOM in billing, claims, eligibility, and authorization processes.

Role requires experience with Medicaid applications in LTC settings, strong computer skills, and the ability to travel as needed. This is a full-time, on-site position offering comprehensive benefits.

Qualifications

• Experience in Medicaid application/renewal process in LTC facilities.
• TMHP and SimpleLTC portals knowledge preferred.
• Proficient computer skills.
• Well organized and able to multitask.
• Attention to detail.
• Travel ability with valid driver’s license and auto insurance.

Responsibilities

• Review referrals and Medicaid questionnaire from facilities to determine Medicaid eligibility.
• Review all applications and supporting documentation before submission to HHSC.
• Communicate with residents and/or family regarding the application process and needed documentation.
• Maintain tracking system for Medicaid Pending residents to approval.
• Monitor Medicaid renewals to avoid coverage interruption.
• Email facility and Regional BO Consultant to obtain information for applications/renewals.
• Attend biweekly calls with facilities and Regional BO Consultant to discuss statuses, approvals, denials.
• Assist training Business Office staff on Medicaid application process.
• Report delays, barriers or denials to the Senior Medicaid Advocate.
• Report weekly on outstanding items and denial statuses.
• Ensure compliance with State laws and Organization’s Compliance Plan and Code of Ethics.
• May assist other departments within Central Billing Office.
• Other duties may be assigned with or without notice.

Skills

Proficient computer skills

Well organized

Multitask

Attention to detail

Travel ability

Tools

TMHP portals

SimpleLTC portals

Job description

Opco-Skilled-Management- seeks a Medicaid Advocate to oversee Medicaid eligibility reviews and renewals for assigned facilities, ensuring timely coverage across payer types. You will support Regional AR staff, BOM, and ABOM in billing, claims, eligibility, and authorization processes.

Role requires experience with Medicaid applications in LTC settings, strong computer skills, and the ability to travel as needed. This is a full-time, on-site position offering comprehensive benefits.