Become a part of our caring community and help us put health first
 

As a Healthcare Authorization/Revenue Specialist, you will:

• Daily audit of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met.

• Verify patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for timely, accurate revenue recognition

• Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate.

• Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue.

• Prepare and submit invoices to Accounts Payable for reimbursement and performs follow up to ensure accurate, timely payments are made to our facility partners

• Prepare, submit and follow up on authorization and re-authorization requests according to applicable state and commercial payor guidelines.

• Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing

• Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.

• Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.

• Alerts appropriate team members at the Site regarding late or missing documents required for billing.

• Establish and maintain positive working relationships with Sites, Nursing Home Facilities, and AR Teams.

• Maintain the confidentiality of patient/client and agency information at all times.

• Maintain accurate and up to date information for all vendor and nursing facility contracts.

• Keep information in an orderly manner readily accessible for review. Presents status as requested.

• Assure for compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures

• Participate in special projects and performs other duties as assigned.

• Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary.

• Act as an information resource for any hard revenue generation issues or system issues. Basically the subject matter expert.

• Assure the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards.

Use your skills to make an impact
 

Required Experience/Skills:

• One to two years related experience and/or training preferred.

• Two years Home Health care or Medical Office experience preferred.

• Knowledge of insurance reimbursement and authorization process preferred.

• Skilled in the use of computers and the Microsoft Office applications. 

• HealthCare System knowledge is preferred.

• Two years college preferred.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$37,200 – $51,200 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.