Medicaid Billing Specialist Remote

Full-time position.

About the role

The Medicaid Advocate will review Medicaid Pending applications and Medicaid renewals for assigned facilities to ensure Medicaid eligibility and obtain timely coverage and approvals. Provides ongoing support to Regional AR staff, BOM, and ABOM in billing, claims, eligibility, and authorization processes for all payer types, including Medicaid, Medicare, and Managed Care.

Responsibilities

• Review referrals and Medicaid questionnaires from assigned facilities to determine eligibility for Medicaid.
• Review all applications and supporting documentation prior to submitting to HHSC.
• Communicate with residents and/or family members regarding the application process and required supporting documentation.
• Maintain a tracking system for all assigned Medicaid Pending residents until approval.
• Maintain a tracking system to monitor Medicaid renewals and avoid interruption in coverage.
• Email communication with facilities and Regional Business Office Consultants to obtain information needed for applications or renewals.
• Attend biweekly calls with assigned facilities and Regional Business Office Consultants to discuss statuses, approvals, denials, and any required facility information.
• Assist with training Business Office staff on the Medicaid application process as needed.
• Report delays, barriers, or denials to the Senior Medicaid Advocate.
• Provide weekly reports to the Senior Medicaid Advocate on outstanding items for application/renewal completion and denial statuses.
• Ensure compliance with all State laws related to the position.
• Adhere to the Organization’s Compliance Plan and Code of Ethics.
• Occasionally assist other departments within the Central Billing Office.
• Perform other duties, responsibilities, and activities as assigned or required.

Requirements

• Experience in the application/renewal process for Medicaid in LTC facilities.
• Experience with TMHP and SimpleLTC portals preferred.
• Proficient computer skills.
• Well-organized and able to multitask.
• Strong attention to detail.
• Ability to travel, including a valid driver’s license and automobile insurance.

Benefits

• Healthcare
• Dental
• Vision
• Paid time off (PTO)
• 401K