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Director of Home Health Authorizations, Eligibility – Payor Maintenance
Location
Florida
Posted
95 days ago
Salary
$115.2K - $158.4K / year
Seniority
Lead
Job Description
Director of Home Health Authorizations, Eligibility – Payor Maintenance
CenterWell Senior Primary Care
• Develop and execute a comprehensive authorization, eligibility reverification and payor encounter maintenance strategy aligned with enterprise revenue cycle objectives. • Serve as the organizational subject-matter expert on payer authorization rules, revalidation requirements, and medical necessity workflows. • Lead large-scale transformation initiatives including centralization, workflow redesign, automation, and performance standardization. • Establish governance, escalation paths, and performance accountability across a complex, multi-site organization. • Direct day-to-day authorization, eligibility reverification and payor encounter maintenance operations across all service lines and payers. • Ensure timely and accurate submission, tracking, and renewal of authorizations in Homecare Homebase. • Oversee management of payer portals, authorization queues, and work distribution. • Ensure consistent execution across onshore and offshore teams. • Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams. • Partner with nursing leadership, therapy leadership, and clinical staff to ensure clinical documentation supports medical necessity. • Support resolution of clinical questions related to authorization determinations. • Collaborate with Quality, Compliance, and Audit teams to support medical reviews and audits. • Translate payer requirements into operational workflows and staff education. • Define, monitor, and report KPIs including authorization turnaround time, authorization success rate, denial rate, and authorization-related delays. • Use data to identify trends, root causes, and improvement opportunities. • Present performance insights to executive leadership. • Drive continuous improvement using Lean, Six Sigma, or similar methodologies. • Ensure compliance with Medicare, Medicaid, and commercial payer authorization and revalidation requirements. • Maintain audit-ready documentation and processes. • Support external audits (MAC, SMRC, RAC, UPIC) and payer reviews related to authorization. • Partner with Compliance and Legal teams on corrective action plans. • Lead, coach, and develop managers, supervisors, and frontline authorization staff. • Manage blended onshore/offshore workforce models. • Establish clear roles, performance expectations, and career pathways. • Promote accountability, engagement, and operational excellence.
Job Requirements
- Bachelor’s degree in Healthcare Administration, Business, Nursing, or related field required.
- Master’s degree (MHA, MBA, MSN, or similar) preferred.
- 8 or more years of progressive experience in healthcare revenue cycle or access operations.
- Minimum of 5 years leading authorization or insurance verification functions.
- Experience in large, complex, multi-site healthcare organizations.
- Demonstrated experience leading centralized and distributed (onshore/offshore) teams.
- Direct experience working with Homecare Homebase strongly preferred.
- Experience supporting Medicare, Medicare Advantage, Medicaid, and commercial payers.
- Proven success leading transformational or enterprise-scale process improvement initiatives.
Benefits
- 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
- many other opportunities
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