Revenue Integrity & Authorization Manager

Elite Home Health Care, Inc.; New York (NY); In loco; USD 80.000 - 85.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical Insurance

PTO & Sick Time

Referral Program

Descrizione del lavoro

Elite Home Health Care is seeking a senior authorization and pre-billing leader to manage end-to-end home care authorizations, staffing decisions, and billing integrity. This on-site role collaborates with branch managers to review visits, monitor payor rules, and drive zero billing holds.

You will own reporting on authorization volumes, turnaround times, expirations and overutilization, ensuring seamless conversion of temporary to permanent authorizations.

Competenze

• Supervisory or management experience in a home care, LHCSA, or managed care authorization/billing environment.
• Working knowledge of HHAeXchange required; ePaces required.
• Familiarity with MLTC, CHHA, and third-party payor authorization processes.
• Strong command of revenue cycle and pre-billing mechanics.
• Ability to manage a team through high-volume, time-sensitive workflows.

Mansioni

• Owns the full authorization lifecycle across all payors: new authorizations, reauthorizations, increases, decreases, extensions, retroactive authorizations.
• Manages the Authorization Coordinator team and their payor portfolios; ensures cross-coverage during absences.
• Owns authorization tracking, expiration monitoring, and daily payer follow-up as a managed process.
• Escalates high-risk cases: imminent expirations, high-hour patients, pediatric and fragile patients.
• Maintains current working knowledge of payor rules across the full payor set.
• Owns the weekly pre-billing authorization review ahead of every billing run.
• Compares authorized hours to scheduled hours; resolves blockers to claims submission.
• Accounts for zero billing holds caused by missing or incorrect authorizations.
• Owns identification and resolution of overutilization and reports patterns by payor and branch.
• Works with branch managers to review all authorized visits and staffing decisions.
• Oversees temporary authorization processes and ensures conversion to permanent authorizations.
• Owns reporting mechanisms on authorization and pre-billing; delivers to leadership.

Conoscenze

Supervisory experience

Team management

Revenue cycle

HHAeXchange

ePaces

MLTC/CHHA payor knowledge

Billing discipline

Strumenti

HHAeXchange

ePaces

Descrizione del lavoro

Elite Home Health Care is seeking a senior authorization and pre-billing leader to manage end-to-end home care authorizations, staffing decisions, and billing integrity. This on-site role collaborates with branch managers to review visits, monitor payor rules, and drive zero billing holds.

You will own reporting on authorization volumes, turnaround times, expirations and overutilization, ensuring seamless conversion of temporary to permanent authorizations.