Medicaid Billing Specialist (Onsite)

Adelante Development Center•Albuquerque, NM

5d•Onsite

About The Position

Behind every successful Medicaid claim is someone who cares about accuracy, problem-solving, and making a difference. As a Medicaid Billing Specialist at Adelante, you'll play an important role in ensuring our programs receive the funding needed to provide life-changing services for people with disabilities, seniors, and other underserved members of our community. In this role, you'll help people with disabilities and other disadvantaged populations by ensuring accurate, timely billing and reimbursement for Medicaid-covered services provided across the organization’s programs in New Mexico.

Requirements

High School Diploma or GED required.
Working knowledge of medical reimbursement processes, claim forms, and insurance follow-up.
Must pass pre-employment drug and TB screen, and Agency, Federal and State Department of Health background investigations.
Must have own, reliable transportation and an insurable driving record.
Must possess a valid NM driver's license, and proof of auto liability insurance.
Position is within normal limits of an administrative office position.
Must be able to sit, stand or otherwise perform typing/keyboarding tasks as required to perform the essential duties of position.
Must be able to stand, walk, bend, stoop, and reach above shoulder(s) frequently.
Must be able to carry, lift 10-15 lbs. occasionally.

Nice To Haves

Associate degree in Accounting, Healthcare Administration, Business, or related field preferred.
1-3 years of Medical or Medicaid billing experience in healthcare, behavioral health, home and community-based services, or similar setting preferred.
Experience billing New Mexico Medicaid and/or Medicaid managed care organizations strongly preferred.

Responsibilities

Prepare and submit Medicaid claims accurately and on time while following federal, state, and payer guidelines.
Verify billing information, including client eligibility, authorizations, coding, and supporting documentation before claims are submitted.
Monitor and resolve denied or unpaid claims by researching issues, making corrections, and resubmitting claims when needed.
Review payments and remittance advice to ensure claims are processed correctly and identify billing trends or discrepancies.
Collaborate with internal teams and external payers to resolve claim issues and gather missing information.
Maintain compliance with New Mexico Medicaid regulations, HIPAA requirements, and billing policies.
Track billing activity and prepare reports to help monitor claims, collections, denials, and outstanding accounts.
Provide exceptional customer service by responding professionally to billing questions while maintaining confidentiality.
Support continuous improvement efforts by participating in training, team meetings, and process improvement initiatives.
Perform other duties as assigned.