Lifecare Home Health Family

Role Description The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement. Qualifications - High school diploma or equivalent - Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification - Knowledge of prior authorization processes for home health services - Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers - Strong attention to detail and ability to manage multiple authorizations simultaneously - Proficient in EMR systems (Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel) - Reliable high-speed internet and private, HIPAA-compliant workspace Requirements - Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.) - Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans - Submit complete authorization requests with required clinical documentation within payer timelines - Track authorization status and follow up with payers until determinations are received - Communicate authorization approvals, denials, and limitations to intake and clinical teams - Ensure all authorizations are accurately documented in the EMR/system - Maintain compliance with payer contracts, state regulations, and agency policies - Monitor authorization expiration dates and initiate renewals to prevent service disruption - Support audits by providing authorization documentation as requested - Work closely with clinicians to obtain clinical notes, orders, and supporting documentation - Communicate with physician offices regarding orders and authorization requirements - Serve as a liaison between the agency and insurance companies - Respond promptly to internal and external inquiries regarding authorization status - Identify authorization denials or partial approvals - Assist with gathering documentation for appeals when applicable - Escalate complex authorization issues to leadership as needed Benefits - Fully remote, home-based role - Standard business hours aligned with operations - May require coordination across time zones

Description Join Life Care Home Health Family! ServingServing Texas, Florida, Nevada, Georgia, and Arizona, we provide skilled nursing, therapy, homecare, hospice, palliative care, and private duty services. Why Work With Us? - Nestmed AI Scribe: Less charting, more caring! - Competitive pay, 401k, health & life insurance - Flexible schedules & career growth opportunities - Continuing education & recognition programs - Supportive, family-like team culture Make a difference in patients’ lives while enjoying work-life balance. Apply today and grow with us! Position Summary The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement. Key Responsibilities Authorization & Payer Coordination - Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.). - Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans. - Submit complete authorization requests with required clinical documentation within payer timelines. - Track authorization status and follow up with payers until determinations are received. - Communicate authorization approvals, denials, and limitations to intake and clinical teams. Documentation & Compliance - Ensure all authorizations are accurately documented in the EMR/system. - Maintain compliance with payer contracts, state regulations, and agency policies. - Monitor authorization expiration dates and initiate renewals to prevent service disruption. - Support audits by providing authorization documentation as requested. Collaboration & Communication - Work closely with clinicians to obtain clinical notes, orders, and supporting documentation. - Communicate with physician offices regarding orders and authorization requirements. - Serve as a liaison between the agency and insurance companies. - Respond promptly to internal and external inquiries regarding authorization status. Denials & Appeals Support - Identify authorization denials or partial approvals. - Assist with gathering documentation for appeals when applicable. - Escalate complex authorization issues to leadership as needed. Requirements Required Qualifications - High school diploma or equivalent - Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification. - Knowledge of prior authorization processes for home health services - Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers. - Strong attention to detail and ability to manage multiple authorizations simultaneously. - Proficient in EMR systems ( Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel). - Reliable high-speed internet and private, HIPPA-compliant workspace Skills & Competencies - Strong organizational and time-management skills - Clear written and verbal communication - Problem-solving and follow-up driven mindset - Ability to work independently and as part of a team - Professional phone etiquette and customer service skills Work Environment - Fully remote, home-based role - Standard business hours aligned with operations - May require coordination across time zones

Description Join Life Care Home Health Family! Serving Texas, Florida, Nevada, and Georgia, we provide skilled nursing, therapy, homecare, hospice, palliative care, and private duty services. Why Work With Us? - Nestmed AI Scribe: Less charting, more caring! - Competitive pay, 401k, health & life insurance - Flexible schedules & career growth opportunities - Continuing education & recognition programs - Supportive, family-like team culture Make a difference in patients’ lives while enjoying work-life balance. Apply today and grow with us! Position Summary The Billing Resolution Specialist is responsible for monitoring, resolving, and coordinating follow-up on delayed, denied, or rejected insurance claims billed by a third-party billing company. This role serves as the internal owner of claim resolution, ensuring timely corrections, rebilling, and payment while working closely with clinical, intake, and billing partners. Key Responsibilities - Monitor A/R aging and identified claim issues related to eligibility, authorizations, Oasis, coding, documentation or timely filing. - Partner with clinical, intake, authorization and QA teams to obtain required corrections, including Oasis updates, eligibility verification, authorization and payer corrections when applicable. - Act as an internal liaison with the third-party billing company to ensure timely actions are taken to resolve delays. - Push back when rebill timelines are missed; root causes are not documented; denials repeat without correction - Escalate recurring issues and high-risk claims to Director of RCM and leadership - Support revenue cycle improvement initiatives and assignments as needed - Oversee adding of payers to the EMR; communicate payer specific requirements to appropriate teams - Assist with processing approved write-offs and AR collections adjustments as needed. - Assist as needed with patient invoicing Requirements Qualifications - 3+ years home health billing, A/R, or claims follow-up experience - Strong knowledge of Medicare Home Health billing (NOA, PDGM) - Familiarity with payer denials and timely filing requirements - Experience working with third-party billing vendors preferred - Working knowledge of EMR ( HCHB, Wellsky/Kinnser/Consolo) - Strong attention to detail and follow-through Skills - Well informed on compliance and payer requirements - Claims analysis and problem resolution - Vendor and cross-functional coordination - Strong organizational and communication skills Work Environment - Office, remote, or hybrid setting depending on agency policy - Standard business hours with flexibility based on workload

Description Join Life Care Home Health Family! ServingServing Texas, Florida, Nevada, Georgia, and Arizona, we provide skilled nursing, therapy, homecare, hospice, palliative care, and private duty services. Why Work With Us? - Nestmed AI Scribe: Less charting, more caring! - Competitive pay, 401k, health & life insurance - Flexible schedules & career growth opportunities - Continuing education & recognition programs - Supportive, family-like team culture Make a difference in patients’ lives while enjoying work-life balance. Apply today and grow with us! Position Summary The Remote Home Health Authorization Specialist is responsible for obtaining, tracking, and maintaining prior authorizations for home health services in compliance with payer requirements. This role works closely with intake, clinical staff, physicians’ offices, and insurance providers to ensure timely approval of services, minimize delays in care, and support accurate reimbursement. Key Responsibilities Authorization & Payer Coordination - Obtain prior authorizations and re-authorizations for home health services (Skilled Nursing, PT, OT, ST, HHA, MSW, etc.). - Verify insurance eligibility, benefits, and authorization requirements for commercial, Medicare Advantage, and Medicaid plans. - Submit complete authorization requests with required clinical documentation within payer timelines. - Track authorization status and follow up with payers until determinations are received. - Communicate authorization approvals, denials, and limitations to intake and clinical teams. Documentation & Compliance - Ensure all authorizations are accurately documented in the EMR/system. - Maintain compliance with payer contracts, state regulations, and agency policies. - Monitor authorization expiration dates and initiate renewals to prevent service disruption. - Support audits by providing authorization documentation as requested. Collaboration & Communication - Work closely with clinicians to obtain clinical notes, orders, and supporting documentation. - Communicate with physician offices regarding orders and authorization requirements. - Serve as a liaison between the agency and insurance companies. - Respond promptly to internal and external inquiries regarding authorization status. Denials & Appeals Support - Identify authorization denials or partial approvals. - Assist with gathering documentation for appeals when applicable. - Escalate complex authorization issues to leadership as needed. Requirements Required Qualifications - High school diploma or equivalent - Minimum 2 + years’ experience in home health, healthcare authorization, intake, or insurance verification. - Knowledge of prior authorization processes for home health services - Familiarity with Medicare Advantage, Medicaid MCOs, and commercial payers. - Strong attention to detail and ability to manage multiple authorizations simultaneously. - Proficient in EMR systems ( Kinnser/Wellsky) and Microsoft Office (Outlook, Word, Excel). - Reliable high-speed internet and private, HIPPA-compliant workspace Skills & Competencies - Strong organizational and time-management skills - Clear written and verbal communication - Problem-solving and follow-up driven mindset - Ability to work independently and as part of a team - Professional phone etiquette and customer service skills Work Environment - Fully remote, home-based role - Standard business hours aligned with operations - May require coordination across time zones

Description Position Summary: The Hospice RC Specialist is responsible for managing, reviewing, validating and coordinating all Room & Board, GIP/Respite invoicing for hospice operations. This role ensures accurate billing, timely payments, strong vendor relationships, and compliance with Medicare and Medicaid billing standards. This position ensures that company’s claims billed to payors are processed in compliance with the States Medicaid and Managed Care Organization (MCO) regulations, verify patient eligibility, monitor authorizations, resolve denied claims, and support the financial operations of the hospice organization. The Specialist serves as a key point of communication between hospice agencies, vendors, clients and will report directly to the Director of Revenue Cycle Management. Key Responsibilities: Medicaid Invoicing & GIP Claims Management - Verify that patient benefit periods, levels of care, and election information are correct prior to billing. - Prepare, submit, and track Medicaid room and board charges according to state and federal guidelines, including rate changes and patient liability. - Manage all aspects of Room & Board invoicing for assigned hospice agencies to include verifying correct R&B billing rates and invoice accuracy. - Review, update, validate and approve GIP/Respite invoices and prepare for AP processing. - Monitor claim status, follow up on unpaid Medicaid or denied claims, and assist with actions required to correct claims as needed - Maintain accurate records of all claims, payments, and adjustments Eligibility, Authorizations & Documentation: - Verify resident eligibility and enrollment in Medicaid programs such as managed care plans or traditional Medicaid at admission and regular intervals throughout a patient’s benefit period. - Obtain authorizations according to payor/plan requirements by State, plan enrollment, managed care assignments, and facility contracts. Communication & Collaboration: - Coordinate with admissions, clinical teams, social workers, and facility partners to ensure accurate billing information. - Identify discrepancies and work with facility partners or internal departments to resolve them. - Communicate effectively with clients, vendors and internal teams, including corporate billing and agency leadership. - Participate in internal meetings, team discussions as requested. - Perform other related duties as assigned or incidental to the essential functions of the position. Requirements Required Qualifications: - High school diploma or equivalent; -Minimum 2 years medical billing experience related to room & board, long-term care, managed care hospice billing. - Familiarity with hospice levels of care; routine home care, respite and continuous care and general inpatient (GIP) - Strong knowledge of Medicaid billing guidelines, coding, and reimbursement processes. - Excellent communication skills and ability to work collaboratively with facility partners and internal teams. - Strong attention to detail and accuracy. - Working knowledge of Wellsky/Consolo EMR, including navigation, documentation review and extracting billing -related data. Work Environment: - Full-time position - Remote, hybrid, or on-site depending on organizational needs - Fast paced healthcare billing environment requiring consistent attention to deadlines