Revenue Cycle & Claims Resolution Specialist at AW Health Care

University City, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

26 May, 26

Salary

35.0

Posted On

25 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Verification, Medicare Advantage Authorizations, Prior Authorizations, Billing Support, Eligibility Verification, EMR Systems, Payer Portals, Denial Resolution, Time Management, Problem Solving, Communication, OASIS, PDGM, ICD-10, CPT, HCPCS

Industry

Hospitals and Health Care

Description

Description Looking for a Job You Love—and More Time with Your Family? AW Health Care is currently seeking a full-time Revenue Cycle & Claims Resolution Specialist for our Home Health team. The position can will be located in one of our convenient office locations throughout the Metro St Louis area based on the most qualified candidate's preferred location. With a flexible schedule, excellent clinical outcomes, and strong patient satisfaction, this role is designed for professionals who want to make a difference—without sacrificing personal time. About AW Health Care: AW Health Care is a woman-owned, independent home health agency based in St. Louis, proudly serving Missouri and Illinois for over 25 years. With more than 500 team members supporting over 1,500 patients, we are committed to delivering innovative, patient-centered care that makes a difference. Why Join AW Health Care? We offer a comprehensive benefits package, including: Medical, Dental, and Life Insurance 401(k) with Company Match of 4% Paid Time Off (PTO) Supplemental benefits (Short/Long-Term Disability, AD&D, Additional Life Insurance) Position Summary The Revenue Cycle & Claim Resolution Specialist is responsible for verifying insurance coverage, obtaining and managing prior authorizations, and supporting accurate billing for home health services, with a primary focus on Medicare, Medicaid and Medicare Advantage plans. This role works closely with intake, clinical, scheduling, and billing teams to ensure timely start of care, compliance with payer requirements, and appropriate reimbursement. Key Responsibilities Insurance Verification & Front-End Revenue Cycle Verify patient eligibility, benefits, and coverage for home health services Confirm plan type (Traditional Medicare vs. Medicare Advantage) and identify delegated UM entities Review benefits for visit limits, authorization requirements, and covered disciplines (SN, PT, OT, ST, HHA, MSW) Communicate eligibility findings and restrictions to clients, intake and clinical teams Document all verification details accurately in EMR and billing systems Escalate coverage discrepancies to intake leadership as needed Medicare Advantage Authorizations Obtain initial, ongoing, and recertification authorizations for Medicare Advantage patients Submit clinical documentation (OASIS, therapy evaluations, visit plans, physician orders) per payer guidelines Track authorization timelines and proactively follow up to prevent delays or interruptions in care Notify teams of approvals, partial approvals, denials, and changes to authorized visit counts Revenue Cycle Management - Billing & Claims Support (Home Health) Ensure authorization data aligns with scheduled visits and services rendered Review billing information for accuracy prior to claim submission Support timely claim submission to Medicare Advantage payers and delegated UM entities Track denial trends and report to leadership Assist with resolving claim denials, underpayments, and authorization-related billing issues Compliance & Documentation Maintain accurate documentation in the EMR and billing systems to support compliant reimbursement Ensure adherence to Medicare Conditions of Participation and Medicare Advantage payer requirements Stay current on Medicare Advantage policies, authorization rules, and documentation standards Communication & Collaboration Serve as a liaison between home health agency staff and insurance payers/UM vendors Collaborate with intake, case management, therapy, scheduling, and billing teams to ensure continuity of care Provide clear, timely communication regarding authorization status and payer requirements Requirements Required 3+ years of experience in insurance verification, Medicare Advantage authorizations, or billing Strong knowledge of Medicare Advantage home health authorization processes Experience working with EMR systems and payer portals High attention to detail and strong organizational skills Preferred Associate’s degree or certification in medical billing, coding, or healthcare administration Experience with home health EMRs Familiarity with Medicare Advantage UM vendors and payer portals (e.g., Availity, Carelon, Essence, UHC, & Waystar) Understanding of OASIS, PDGM, iQIES, ICD-10, CPT, and HCPCS codes Key Skills & Competencies Ability to manage high-volume Medicare Advantage authorizations Strong follow-up and time-management skills Problem-solving and denial resolution experience Ability to work independently in a fast-paced home health environment Excellent written and verbal communication skills Performance Expectations Timely completion of eligibility verification and authorizations Accurate documentation supporting clean claims and reduced denials Consistent collaboration with clinical and billing teams

Responsibilities

The specialist is responsible for verifying insurance coverage, obtaining and managing prior authorizations, and supporting accurate billing for home health services, focusing primarily on Medicare, Medicaid, and Medicare Advantage plans. This involves collaborating with intake, clinical, scheduling, and billing teams to ensure timely service start, compliance with payer requirements, and appropriate reimbursement.