Home Health Insurance Authorization Specialist
Not Disclosed•Full-TimeRemote
location_onCarlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
About the Team
CenterWell Home Health specializes in personalized, comprehensive home care for patients managing chronic conditions or recovering from injury, illness, surgery, or hospitalization. Our care teams—comprising nurses, therapists, aides, and social workers—work together to help patients rehabilitate, recover, and regain their independence. As part of CenterWell, a leading healthcare services business and a wholly owned subsidiary of Humana, we are focused on whole health, addressing the physical, emotional, and social wellness of our patients through integrated and differentiated experiences.
About the Role
As a Home Healthcare Insurance Authorization Specialist, you will become a vital part of our caring community, ensuring that revenue is recognized appropriately and that all conditions of payment are met. You will report directly to the Authorization Supervisor and serve as a subject matter expert for revenue generation and system issues. Your day-to-day involves auditing admission and discharge documentation, verifying patient eligibility, and coordinating authorization requests in compliance with state and commercial payor guidelines. You will also generate site revenue reports, resolve billing errors, and maintain positive working relationships with nursing home facilities and Accounts Receivable teams. This role is critical to maintaining the financial health of our care delivery while upholding the highest standards of patient confidentiality and compliance.
Work Environment & Requirements
This is a full-time remote position scheduled for 40 hours a week, Monday through Friday. The shift hours are 8:30 AM to 5:00 PM CST (9:30 AM to 6:00 PM EST). To ensure effective remote work, employees must have a dedicated workspace free from ongoing interruptions to protect member PHI/HIPAA information. A reliable internet connection is required, with a minimum of 25 Mbps download and 10 Mbps upload speeds; satellite or cellular connections require leadership approval. While the role is remote, occasional travel to Humana offices may be necessary for training or meetings. Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses, and appropriate telephone equipment will be provided.
Our Commitment to Diversity
Humana is an Equal Opportunity Employer. It is our policy not to discriminate against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We are committed to taking affirmative action to employ and advance individuals with disabilities or protected veteran status in compliance with federal laws. CenterWell also complies with all applicable federal civil rights laws, does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion, and provides free language interpreter services to ensure accessibility for all.
Work location
Work model: Remote
Carlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
Santa Fe, New Mexico
Key Responsibilities
- check_circleAudit admission and discharge documentation to ensure appropriate revenue recognition
- check_circleVerify patient eligibility and payor coverage guidelines for accurate billing
- check_circlePrepare and submit invoices to Accounts Payable for facility partner reimbursement
- check_circleSubmit and follow up on authorization and re-authorization requests per payor guidelines
- check_circleCoordinate documentation and data entry to ensure compliance with Medicare and Medicaid requirements
- check_circleAssist with training newly-hired associates and re-educate revenue teams as necessary
- check_circleCommunicate with site leadership regarding outstanding documentation or revenue loss risks
- check_circleGenerate site revenue reports and resolve batch errors and bill holds
Requirements
- verifiedOne or more years of related experience and/or training
- verifiedTwo or more years of Home Healthcare or Medical Office experience
- verifiedKnowledge of insurance reimbursement and authorization process
- verifiedProficient in Microsoft Office (Word, Excel, Outlook)
- verifiedTwo years college
- verifiedDownload speed of 25 Mbps and upload speed of 10 Mbps
- verifiedWork from a dedicated space lacking ongoing interruptions
Nice to Have
One or more years of related experience and/or training. Two or more years of Home Healthcare or Medical Office experience. Knowledge of insurance reimbursement and authorization process. Two years of college education.
Benefits & Perks
check_circleMedical, dental, and vision insurancecheck_circle401(k) retirement savings plancheck_circlePaid time off, company holidays, volunteer time off, paid parental and caregiver leavecheck_circleShort-term and long-term disability insurancecheck_circleLife insurancecheck_circleBi-weekly internet expense payment for employees in California, Illinois, Montana, or South Dakotacheck_circleTelephone equipment provided for Home or Hybrid Home/Office employees
