OOS Senior Claim Specialist

Elevate Patient Financial Solutions®; Albuquerque (NM); On-site; USD 45,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

401K match

PTO

Holidays & floating days

Elevate Day

Pet Insurance

Employee referral bonus

Teamwork & growth

Job summary

Elevate Patient Financial Solutions is seeking a Senior Claim Specialist to join a hospital-based team in Albuquerque, New Mexico. This full-time role focuses on Medicaid eligibility, enrollment, and payment posting, with a Monday–Friday schedule from 8:00am to 4:30pm.

You will verify eligibility and authorizations, submit enrollment applications, perform data entry, and reconcile payments while ensuring HIPAA compliance and outstanding client service.

Qualifications

• High School Diploma or GED required.
• 2-3 years of related experience in healthcare or a related area.
• Excellent verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Ability to multi-task and manage competing priorities.
• Proficient with data entry, word processing, MS Office, and navigating multiple web-based applications.

Responsibilities

• Confirm Medicaid eligibility and authorization requirements.
• Submit authorization requests to Medicaid payers and follow up for timely resolutions.
• Perform manual data entry of patient accounts and claim forms.
• Gather and maintain credentials from hospitals and physicians.
• Coordinate enrollment applications with hospitals and physicians.
• Submit enrollment applications and follow up to ensure processing.
• Manage and comply with enrollment guidelines.
• Update enrollment status and documentation in software systems.
• Provide strong customer service and respond to client inquiries within 24 hours.
• Research documentation to post unapplied cash and perform reconciliation reports.
• Review Medicaid payments for accuracy and post to cash posting systems.
• Facilitate timely payment from Medicaid payers and ensure HIPAA/FDCPA compliance.
• Maintain clear, concise account notation and monitor status with management and clients.

Skills

Medicaid eligibility

Medicaid enrollment

Payment posting

Data entry

HIPAA compliance

Account reconciliation

MS Office

Education

High School Diploma or GED

Tools

MS Office Suite

EHR software

Job description

Elevate Patient Financial Solutions has an exciting career opportunity available as a OOS Senior Claim Specialist. This position will be located within a hospital in Albuquerque, New Mexico. The Full-Time schedule for this role will be Monday-Friday 8:00am-4:30pm.

Job Summary

Elevate PFS provides revenue cycle solutions to hospitals and physicians throughout the United States. This includes AR support for Out-of-State Medicaid accounts. The purpose of this position is to conduct Medicaid eligibility, authorization, enrollment, and payment posting functions.

Essential Duties And Responsibilities

• Confirm eligibility and authorization requirements for Medicaid patients.
• Submit authorization requests to Medicaid payers and perform appropriate follow up to ensure authorization requests are resolved in a timely manner.
• Perform manual data entry of patient accounts and or claim forms.
• Gather and maintain credentials from hospitals and physicians.
• Coordinate with hospitals and physicians to accurately complete Medicaid enrollment applications.
• Submit hospital and physician enrollment applications to Medicaid payers and complete timely follow up to ensure applications process correctly.
• Manage and comply with client and Medicaid enrollment guidelines.
• Update enrollment status, documentation, and information in software system.
• Provide strong customer service to clients and provide responses to client inquiries within 24 hours.
• Research and obtain necessary documentation to post unapplied cash.
• Complete payment reconciliation reports on a weekly or monthly basis.
• Review Medicaid payments for accuracy and submit payment information to the cash posting team.
• Facilitate timely payment from Medicaid payers.
• Work in compliance with state and federal guidelines, including HIPAA and FDCPA.
• Maintain case clear, concise, and accurate account notation.
• Monitor status of each account and communicate effectively with management, clients, and other parties regarding the status of the accounts.
• Other duties as assigned.

Qualifications And Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

• High School Diploma or GED.
• Working knowledge of ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred.
• 2-3 years of related experience in the healthcare industry or in a related area.
• Excellent verbal and written communication skills.
• Strong organizational skills.
• Ability to multi-task.
• Critical thinking and strong attention to detail.
• Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through multiple web-based applications.

Benefits

ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

ElevatePFS is an Equal Opportunity Employer