OOS Claims Specialist

Elevate Patient Financial Solutions has an excellent career opportunity available as an OOS Claims Specialist. This position is a remote based role. The schedule for this Full\-Time role is 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 conduct Medicaid eligibility, authorization, billing and follow up functions. Essential Duties and Responsibilities Properly identify Medicaid eligibility, authorization, enrollment and documentation requirements for hospital and physician accounts. Training and software to assist with these functions will be provided. 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. Obtain bills, medical records, or other necessary documentation from medical providers in a timely manner. Review and edit claims to ensure they meet state and federal guidelines. Submit claims timely and accurately to Medicaid payers. Perform aggressive follow\-up on unresolved claims. Facilitate timely payment from Medicaid payers. Research denials and/or underpayments and formulate appeal letters and/or disputes to Medicaid plans in accordance with state guidelines. Submit payment details to the cash posting team. Work in compliance with state and federal guidelines, including HIPAA and FDCPA. Maintain case clear, concise, and accurate account notation. Monitor the status of accounts and communicate effectively with management, clients and other parties regarding the status of the accounts. Provide responses to client inquiries within 24 hours. Regular and timely attendance. 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. 1\-2 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. Remote and Hybrid positions require internet connections that meet the Company’s upload and download speed criteria. 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