OOS Senior Claim Specialist

Elevate Patient Financial Solutions®; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

401K

PTO

Paid holidays

Floating holidays

Elevate Day

Job summary

Elevate Patient Financial Solutions in the United States is seeking an experienced Senior Claim Specialist for a remote, full-time role. The position focuses on Medicaid eligibility, enrollment, and payment posting to support hospitals and physicians nationwide.

You will verify eligibility, submit enrollment applications, post payments, and reconcile accounts while ensuring HIPAA compliance and timely client responses. Strong data entry and communication skills are essential.

Qualifications

• High School Diploma or GED.
• Experience with ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred.
• 2-3 years of related healthcare experience.
• Excellent verbal and written communication skills.
• Strong organizational skills and multitasking ability.
• Proficiency with MS Office and data entry.

Responsibilities

• Confirm eligibility and authorization requirements for Medicaid patients.
• Submit authorization requests and follow up to resolve requests.
• Manual data entry of patient accounts and claim forms.
• Gather credentials from hospitals and physicians.
• Coordinate enrollment applications and ensure processing.
• Post payments and perform monthly reconciliation reports.

Skills

Medicaid

Data entry

MS Office

Attention to detail

Communication skills

Education

High school diploma or GED

Job description

Elevate Patient Financial Solutions has an exciting career opportunity available as an OOS Senior Claim Specialist. This position will be remote. The Full-Time schedule for this role will be Monday-Friday 8:00am4:30pm.

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

• 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

• 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