Help at Home is the leading national provider of in-home personal care services, where our mission is to enable individuals to live with independence and dignity at home. Our team supports 66,000 clients monthly with the help of 49,000 compassionate caregivers across 12 states. We’re focused on serving people and the communities we are part of.

Job Summary:

Overall responsibility for the Authorization and Eligibility teams within assigned markets.  Directs the activities of an assigned team, resolves moderately complex problems and is accountable for the accuracy and timeliness of data generated by this function. Primary responsibilities include overseeing authorization and eligibility management for assigned markets, ensuring client access to care, reducing revenue risk to the company, identifying and implementing necessary controls, coaching employees, and general oversight of all team members and processes. This position reports to the RCM manager (Client Access), who oversees the daily revenue cycle operations for RCM Client Access.  

As a People Leader:

• You lead with empathy, vulnerability, and honesty.
• Must have a love of learning.
• Endless curiosity and an enthusiasm for continuous improvement
• Team-first mindset
• Empower and inspire full time associates through coaching.
• Hold others to high standard.
• Knows how and when to celebrate success.

Supervisory Responsibilities:

• Supervises growing team of Authorization Representatives specialized in authorization, eligibility, and account maintenance. 

• Supervises team of offshore Representatives, serves as primary point of contact with offshore leadership. 

• Oversees daily staff time & attendance, PTO requests, and weekly payroll approval. 

• Maintains bi-weekly 1:1 meeting with staff.  

• Assists with creation, review, and delivery of quality scorecards. 

• Coaches employees on minor issues 

• Assists Client Access Manager with creation and delivery of disciplinary actions including verbal counseling, written counseling, final warning, and performance improvement plans. 

• Supervises authorization management process by maintaining complete and accurate records of authorization issues, communications, and resolution steps. 

• Ensures client data is accurately entered in the system, including authorizations, eligibility tracking, and payor information. 

• Communicates with state and managed care organizations for resolution of issues, disputes, and appeals. 

• Mentors and coaches employees to achieve the highest level of staff competency.   

• Conducts staff meetings at regular intervals for informative and educational purposes. 

• Assists Client Access Manager and Director with incorporating company or departmental changes in a timely and effective manner. 

•  Helps ensure departmental goals are met by providing daily guidance to staff to ensure work is completed in a timely and efficient manner. 
• Other leadership duties as assigned. 

Duties/Responsibilities:

Responsibilities include, but are not limited to: 

• Solves moderately complex problems, analyzes information and evaluates results to select the best solution. 

• Assists Client Access Manager with interviews, hiring, and onboarding processes. 

• Communicates with markets about daily issues and problem resolution. 

• Leads projects as needed. 

• Helps drive process improvement by identifying issues and solutions.  

• Assists with RPA creation and usage. 

• Escalates issues to IT as needed, follows up on all service tickets.  

• Assists with creation and maintenance of SOPs / guides. 

• Serves as subject matter expert for all Client Access functions, is the primary resource for Authorization Representatives 

• Assists with creation of reports to identify data entry omissions or departmental issues. 

• Supervises missing authorization and loss of Medicaid eligibility processes to limit revenue risk. 

• Analyzes daily reports and worklists to identify missing or pending authorizations. 

• Communicates with contracted payers for resolution of issues, disputes, and appeals. 

Required Skills and Abilities:

• Possesses personal accountability.  Self-motivated; reliable; strong attention to details; maintains confidentiality; complies with all policies and procedures.   

• Demonstrates maturity and the ability to function as a team member, good communication skills.   

• Able to supervise staff and coach them to improve functioning and overall agency services. Organized, assertive, mature, approachable and open-minded.  Willing to take initiative.  Identifies and progresses toward meeting personal and professional goals. 

• Able to deal with stress and conflict appropriately. 

Education and Experience:

• 2 years healthcare revenue cycle or billing supervisory experience required.
• 3+ years preferred years’ experience of revenue cycle management or billing experience in the healthcare field. Knowledge of Medicaid/Managed Care Organization (MCO) billing practices.

• Experience with electronic health records.  

• Intermediate to advanced computer skills, including use of Microsoft Office applications (e.g. Word, Excel) and knowledge of HHAx, Waystar, and MCO portals preferred.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.

Help At Home is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status.