About Us:A Homely Care LLC is a Home Care Agency committed to providing high-quality care and seamless support for our clients. We are seeking an experienced and detail-oriented Specialist with a background in the home care industry.

Job Title: Full-Time Billing/Authorization Specialist

Job Summary:The Billing Specialist will play a crucial role in supporting our billing management team by overseeing daily billing tasks not only to meet company financial needs but also to monitor any changes in clients' insurance status. Clients may change insurance plans without prior notice, and daily billing helps identify such changes promptly. This role requires a flexible schedule, with availability on Sundays to verify all clock-ins before submission, ensuring everything is finalized by 8 pm.

We are particularly interested in candidates with hands-on experience using home care billing software, as this role involves working with Axxess for caregiver clock-ins and our home care management, as well as Inovalon, our clearinghouse platform where claims are submitted and eligibility is verified.

Key Responsibilities:

1. Daily Billing and Issue Detection:

   • Perform daily billing to ensure timely financial processing and to catch any client insurance changes, such as plan transitions or coverage terminations. In Inovalon, we conduct two eligibility checks weekly, which helps detect any insurance changes or loss of coverage promptly.

2. Electronic Visit Verification (EVV) Oversight:

   • Monitor EVV accuracy in Axxess, our caregiver clock-in/out software, ensuring the accuracy of caregiver work hours and quality care delivery.

3. Prior Authorization Management:

   • Verify and maintain prior authorizations for required services, ensuring accurate documentation for medical necessity. Learn more about Prior Authorization.

4. Claims Submission and Processing:

   • Use Inovalon to submit and manage claims, including eligibility checks and claim status updates. We also rely on the Rhode Island Provider Portal to check client eligibility, authorizations, and detailed claims information. Access Rhode Island Provider Portal.

5. Insurance Eligibility Checks:

   • Conduct regular insurance eligibility checks using Navinet and the Rhode Island Provider Portal. Access Navinet.

6. Billing Code Management:

   • Ensure accuracy in billing using the following codes:
     • S5125– Home care services
       • S5125 UH – Evening
       • S5125 UJ – Night
       • S5125 TV – Weekends and Holidays
     • S5125 U1– Advanced care services
       • S5125 U1 UH – Evening
       • S5125 U1 UJ – Night
       • S5125 U1 TV – Weekends and Holidays
     • S5130 – Homemaker services
     • T1001 – Nurse visit

Qualifications:

• Experience in home care billing, particularly with authorization confirmations and insurance claims.
• Proficiency in Axxess, Inovalon, and familiarity with eligibility platforms like Navinet and Rhode Island Provider Portal.
• Strong organizational skills and attention to detail.
• Availability on Sundays for verification tasks and flexibility to meet an 8 pm completion deadline.

Mission, Vision, and Values:

• Mission: To provide compassionate, innovative, and culturally sensitive care services.
• Vision: To be a guiding light for those in need, providing care that truly feels like home.
• Values: Compassion, Innovation, Diversity, Integrity, Collaboration, Excellence, Customer-Centric Approach.

Company Culture:We are committed to a workplace free from discrimination and foster a welcoming, inclusive environment.

Additional Information:This role is at-will employment. Candidates are encouraged to provide a cover letter and work samples. Please be prepared to discuss your experience with home care billing software during the interview.

Benefits:A comprehensive benefits package, including medical and dental coverage, will be available starting in 2025.