Billing & Authorization Specialist – Medical & Home Care

Evolving Solution Services; Rhode Island; On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Same-day pay

Medical coverage

Job summary

In Home Wellcare, a Rhode Island home care agency, seeks a Billing & Authorization Specialist to handle daily medical/home care billing, verify authorizations, track insurance changes, and submit claims. The role requires on-site presence and familiarity with the RI Medicaid portal.

You will work with Axxess, Inovalon, and NaviNet, handling eligibility checks and claims management. Sunday billing is required, with a collaborative office environment and same-day pay.

Qualifications

• Direct experience with medical or home care billing workflows.
• Proficiency with Axxess, Inovalon, NaviNet, and RI Provider Portal.
• Available Sundays to meet 8 PM billing deadlines; on-site work required; bilingual (Spanish/English) preferred.

Responsibilities

• Daily billing and issue tracking; submit claims and rebill as needed.
• EVV/time tracking oversight and accuracy checks.
• Manage authorizations and verify prior authorizations.

Skills

Medical billing

Attention to detail

Bilingual (Spanish/English)

Tools

Axxess

Inovalon

NaviNet

RI Provider Portal

Job description

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Billing & Authorization Specialist – Medical & Home Care

Providence, RI, US

30+ days ago Requisition ID: 1032

Billing & Authorization Specialist – Medical & Home Care

In Home Wellcare, a licensed home care agency in Rhode Island, is growing quickly and we’re looking for the right person to join our team. This is a great opportunity for someone with billing experience who wants to be part of a mission-driven company, get exposure to both home care and medical billing, and grow with a supportive team. We also offer same-day pay to make things easier for our employees.

This is an on-site position, not remote. It’s best suited for someone with billing experience who’s ready to take their skills to the next level in a collaborative office setting.

Position Summary

The Billing & Authorization Specialist plays a key role in daily billing operations, verifying authorizations, tracking insurance changes, and submitting claims. Because clients can change coverage without notice, daily billing and eligibility checks are essential to prevent service interruptions.

You’ll be working with:

• Axxess – caregiver EVV/time tracking
• Inovalon – clearinghouse/claims
• NaviNet & RI Medicaid Provider Portal – eligibility and authorizations

Sunday billing is required to meet submission deadlines, with flexibility during the week to balance the workload.

Key Responsibilities

• Daily Billing & Issue Tracking – Submit claims, monitor denials, rebill as needed.
• EVV Oversight – Monitor caregiver clock-ins through Axxess for accuracy and compliance.
• Authorization Management – Track, request, and verify prior authorizations.
• Claims Submission – Use Inovalon to submit/manage claims, monitor rejections and updates.
• Insurance Verification – Run daily eligibility checks in NaviNet and RI Medicaid Provider Portal.
• Billing Code Accuracy – Use correct HCPCS codes and modifiers (S5125 – Home Care, S5130 – Homemaker, T1001 – Nurse Visit, plus modifiers UH, UJ, TV, U1).

Qualifications

• Direct experience with medical or home care billing and authorization workflows.
• Proficiency in Axxess, Inovalon, NaviNet, and RI Provider Portal.
• Strong attention to detail and follow-up.
• Available Sundays to meet 8 PM billing deadlines.
• Must work on-site (not remote).
• Bilingual (Spanish/English) strongly preferred.

What We Offer

• Same-day pay
• Medical coverage available
• A welcoming and inclusive workplace
• Opportunities to grow with a fast-paced, mission-driven healthcare company

Our Mission, Vision & Values

• Mission – Provide compassionate, innovative, and culturally sensitive care.
• Vision – To be a guiding light for those in need, offering care that feels like home.