OOS Senior Claim Specialist

New Mexico

Today

Job Description

Elevate Patient Financial Solutions has an exciting career opportunity available as an 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

Numbers & Facts

Location	New Mexico
Website	http://elevatepfs.com/careers/

Skills

Accounts Receivableunmatched
Communication Skillsunmatched
Computer Skillsunmatched
Current Procedural Terminology (CPT)unmatched
Customer Support/Serviceunmatched
Data Entryunmatched
Detail Orientedunmatched
Documentationunmatched
Fair Debt Collection Practices Act (FDCPA)unmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Healthcareunmatched
Healthcare Common Procedure Coding System (HCPCS)unmatched
High School Diplomaunmatched
Hospitalunmatched
ICD-9unmatched
Insuranceunmatched
Internet Applicationunmatched
Medicaidunmatched
Microsoft Officeunmatched
Multitaskingunmatched
Office Equipmentunmatched
Organizational Skillsunmatched
Presentation/Verbal Skillsunmatched
Process Capabilityunmatched
Project Trackingunmatched
Team Playerunmatched
Time Managementunmatched
Unapplied Cashunmatched
Word Processingunmatched
Writing Skillsunmatched

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