OOS Team Lead

Elevate PFS Holdings, Inc. has an excellent career opportunity available for an OOS Claims Specialist Team Lead. This position will be remote. The schedule for this Full-Time role is Monday through Friday 8:00 AM to 4:30 PM.

Elevate 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, 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 plus years of Medicaid experience
• 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 a home internet connection that meets the company’s upload and download speed criteria
• Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

• 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