Director of Home Health Authorizations, Eligibility & Payor Maintenance

CenterWell Home Health • Louisville, KY

2d • Remote

About The Position

A Director of Authorizations & Eligibility is a senior revenue cycle leader responsible for the strategic oversight, operational execution, and continuous improvement of all authorization, insurance eligibility re-verification and payer maintenance for a large, complex Home Health organization operating on the Homecare Homebase (HCHB) platform. This role leads enterprise-wide authorization related operations supporting high-volume, multi-branch environments and ensures timely, compliant payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore and offshore teams. The role also leads transformational initiatives related to centralization, automation, scalability, and payer optimization.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Nursing, or related field required.
• 8 or more years of progressive experience in healthcare revenue cycle or access operations.
• Minimum of 5 years leading authorization or insurance verification functions.
• Experience in large, complex, multi-site healthcare organizations.
• Demonstrated experience leading centralized and distributed (onshore/offshore) teams.
• Direct experience working with Homecare Homebase strongly preferred.
• Experience supporting Medicare, Medicare Advantage, Medicaid, and commercial payers.
• Proven success leading transformational or enterprise-scale process improvement initiatives.
• Deep knowledge of home health authorization, eligibility, and payer rules.
• Strong understanding of clinical workflows and medical necessity.
• Advanced operational and analytical skills.
• Ability to manage complexity, ambiguity, and change.
• Executive-level communication and influence skills.
• Strong collaboration across clinical, operational, and financial teams.
• Expertise in KPI-driven performance management.

Nice To Haves

• Master's degree (MHA, MBA, MSN, or similar) preferred.
• Certified Healthcare Access Manager (CHAM)
• Certified Revenue Cycle Professional (CRCP)
• Lean Six Sigma (Green Belt or higher)
• Project Management Professional (PMP)
• Nursing license (RN or LPN/LVN) preferred but not required

Responsibilities

• Develop and execute a comprehensive authorization, eligibility reverification and payor encounter maintenance strategy aligned with enterprise revenue cycle objectives.
• Serve as the organizational subject-matter expert on payer authorization rules, revalidation requirements, and medical necessity workflows.
• Lead large-scale transformation initiatives including centralization, workflow redesign, automation, and performance standardization.
• Establish governance, escalation paths, and performance accountability across a complex, multi-site organization.
• Direct day-to-day authorization, eligibility reverification and payor encounter maintenance operations across all service lines and payers.
• Ensure timely and accurate submission, tracking, and renewal of authorizations in Homecare Homebase.
• Oversee management of payer portals, authorization queues, and work distribution.
• Ensure consistent execution across onshore and offshore teams.
• Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams.
• Partner with nursing leadership, therapy leadership, and clinical staff to ensure clinical documentation supports medical necessity.
• Support resolution of clinical questions related to authorization determinations.
• Collaborate with Quality, Compliance, and Audit teams to support medical reviews and audits.
• Translate payer requirements into operational workflows and staff education.
• Define, monitor, and report KPIs including authorization turnaround time, authorization success rate, denial rate, and authorization-related delays.
• Use data to identify trends, root causes, and improvement opportunities.
• Present performance insights to executive leadership.
• Drive continuous improvement using Lean, Six Sigma, or similar methodologies.
• Ensure compliance with Medicare, Medicaid, and commercial payer authorization and revalidation requirements.
• Maintain audit-ready documentation and processes.
• Support external audits (MAC, SMRC, RAC, UPIC) and payer reviews related to authorization.
• Partner with Compliance and Legal teams on corrective action plans.
• Lead, coach, and develop managers, supervisors, and frontline authorization staff.
• Manage blended onshore/offshore workforce models.
• Establish clear roles, performance expectations, and career pathways.
• Promote accountability, engagement, and operational excellence.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees