Billing & Authorization Specialist - Medical & Home Care

Job Description

Job Description

IN HOME WELLCARE

Billing and Authorizations Specialist, Home Care

Location: Providence, Rhode Island 02904, on site
Job type: Full time
Reports to: Director of Operations
Industry: Home health care services
Pay: $52,000 to $62,400 per year, based on a 40 hour week

About In Home Wellcare

In Home Wellcare runs on four values. Professional, Ethical, Reliable, and Compassionate. They are not on a wall here, they are how we hire and how we hold each other accountable. We were built on a simple standard, that people deserve better care at home than most of them get. We are CHAP accredited, we serve Providence and the surrounding communities in English and Spanish, and we have grown every year since we opened in 2023.

About the role

We are looking for an experienced Billing and Authorizations Specialist who already works the way our values describe. In this seat those values are specific. Ethical means we bill only for what was truly delivered and we correct our own errors before anyone else finds them. Reliable means authorizations are renewed before they lapse, because a client's care depends on it. Compassionate means remembering that behind every claim is a person waiting on services. Professional means the work is accurate the first time.

You will own billing, claims, prior authorizations, and eligibility verification across Rhode Island Medicaid, Neighborhood Health Plan of Rhode Island, UnitedHealthcare, and private pay. Not one slice of somebody else's revenue cycle. The entire thing, start to finish.

Most agencies split this work between two people or two departments, one handling authorizations and another handling billing. Here it is one seat, which is why we are looking for someone with real depth on both sides and why the pay reflects it. It suits someone who wants to keep growing professionally and expand their career as the company expands.

Responsibilities

• Submit and manage claims accurately and on time through our clearinghouse, correcting exceptions before release
• Track prior authorizations, including effective dates, expirations, approved services, and authorized hours, and renew them before they lapse
• Verify member eligibility and insurance coverage on the required weekly and monthly schedules
• Review remittance reports, identify denials, underpayments, and rejections, and resolve them through correction, resubmission, or appeal
• Prepare and follow up on private pay invoicing alongside our Medicaid and managed care claims
• Monitor electronic visit verification records and confirm visits are complete and accurate before billing
• Work with case managers, payers, coordinators, and the operations team to resolve billing and authorization issues

Qualifications

• 3+ years of hands on medical, home care, or home health billing and prior authorization experience
• Working knowledge of HCPCS codes, modifiers, units, claim denials, appeals, and payer specific eligibility rules
• Direct experience with Medicaid and managed care billing, including prior authorization submission and renewal
• Experience with Axxess, Inovalon, Navinet, and the Rhode Island Medicaid Provider Portal, or comparable electronic visit verification, clearinghouse, and payer systems
• Able to manage several payer portals, deadlines, and claim issues at once without losing track of any of them
• High school diploma or equivalent required; coursework or certification in medical billing and coding is a plus
• Bilingual English and Spanish strongly preferred

How success is measured

• Claims go out on schedule with no backlog beyond one billing cycle
• Authorizations are renewed before they expire, so no client loses service over a lapse
• Denials are worked and resolved within one billing cycle
• Authorization and eligibility blocks flagged by coordinators are cleared within 48 hours

Benefits

• Paid weekly, with same day pay available so you can access what you have earned without waiting for payday
• Health coverage after ninety days, with a company contribution toward a plan you select yourself, so you choose the carrier and network that fit your family
• Paid time off per company policy
• Training and certification support for anyone building on what they already know
• Room to grow as the company grows, reporting directly to the Director of Operations in a seat where your results are visible to the people making decisions

Working here

Billing, coordination, nursing, and human resources work side by side, in English and in Spanish. Problems get solved in the same room rather than passed between departments, and people help before they are asked. It is a professional office with a positive, collaborative culture, and the wins get recognized.

How to apply

Apply with your resume and tell us where you have done this work before, including the billing and payer systems you have used. We review every application and respond to qualified candidates within five business days.

In Home Wellcare is an equal opportunity employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic.

Professional · Ethical · Reliable · Compassionate