Revenue Cycle Representative - Auth & Eligibility

Position Summary

The Home Health (HH) and Hospice (HOS) Authorization & Eligibility Specialist is responsible for verifying insurance coverage, determining patient eligibility, and securing timely authorizations for home health and hospice services. This role ensures accurate and compliant processing to support patient access to care while reducing reimbursement risk. The specialist works closely with clinical staff, referral sources, payers, and internal billing teams to provide exceptional service and efficient coordination.

Key Responsibilities

Authorization & Eligibility

• Verify insurance eligibility and benefits for all incoming home health and hospice referrals.

• Obtain prior authorizations from commercial, Medicare Advantage, Medicaid, and other payers as required.

• Review clinical documentation to ensure authorization requests meet payer requirements.

• Track authorization status, submit updates or re-auth requests, and prevent lapses in coverage.

• Document all eligibility and authorization details accurately within internal systems.

Coordination & Communication

• Communicate authorization requirements and eligibility outcomes to intake, clinical teams, and billing.

• Collaborate with referral partners, including hospitals, physician offices, and case managers.

• Respond promptly to payer inquiries and requests for additional information.

• Serve as a subject matter expert for authorization rules and payer-specific policies.

Compliance & Documentation

• Ensure all processes adhere to payer regulations, CMS guidelines, and organizational policies.

• Maintain detailed, accurate records to support audits and minimize denials.

• Stay current on regulatory changes impacting home health and hospice eligibility or authorization requirements.

Denial Prevention & Issue Resolution

• Identify and address authorization-related issues that may affect reimbursement.

• Work with billing and revenue cycle teams to resolve authorization denials.

• Recommend process improvements to reduce avoidable denials.

Qualifications:

• Minimum one year of progressive Home Health and/or Hospice billing experience preferred.

• Prior experience working with Medicare rules, regulations, billing codes (preferred)

• Education equivalent to a High school diploma, college degree preferred

• Ability to perform basic bookkeeping and compile statistics as needed

• Ability to work independently

• Must be organized and able to multitask

• Strong written and verbal communication skills

• Ability to type, operate computers and office equipment

• Aptitude for learning computer systems

• Ability to perform basic bookkeeping and compile statistics as needed

• Maintain a professional demeanor, courteous and flexible at all times

• Open to dynamic change and ability to thrive in such an environment

• Willingness and ability to work effectively with members of other departments

Joining us is more than saying “yes” to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now! We commit to respond to every applicant.