Electronic Visit Verification (EVV) Specialist

Community Options, Inc.•Princeton, NJ

31d•$65,000

About The Position

Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states. We are now hiring a Full-Time Electronic Visit Verification (EVV) Specialist to provide support in Newtown, PA or Princeton, NJ. The Electronic Visit Verification (EVV) Specialist is the subject-matter expert responsible for ensuring accurate Electronic Visit Verification (EVV) compliance and successful EVV-based claim submission across multiple states. This role owns the identification, prevention, correction, and education related to EVV denials and is accountable for improving clean-claim rates and reducing EVV-related revenue loss. The EVV Specialist partners closely with state-level operational staff, billing teams, and leadership to document state-specific EVV rules, proactively correct issues before claim submission, and drive consistent, compliant EVV practices across the organization.

Requirements

3+ years of hands on experience with EVV systems and EVV-based claim submission
Strong understanding of Medicaid EVV requirements
Proven experience resolving EVV denials and improving claim acceptance
Experience working across multiple states and payers
Ability to interpret payer manuals, state guidance, and denial codes
Strong documentation and process-mapping skills
Excellent communication and training skills
High attention to detail and strong analytical ability
Experience supporting large multi-state provider organizations
Familiarity with common EVV vendors (e.g., Sandata, AuthentiCare, AHCCCS, HHAeXchange, Tellus, CareBridge, etc.)
Revenue cycle or billing background
Experience working with Managed Care Organizations (MCOs)
Knowledge of home care, personal care, or waiver services

Responsibilities

Serve as the organization’s EVV subject-matter expert for assigned states
Learn, maintain, and document state-specific EVV requirements
Monitor regulatory changes and payer updates impacting EVV compliance
Identify the top EVV denial reasons by payer and state
Develop and enforce pre-submission EVV validation processes to prevent denials
Ensure EVV visits are properly matched to claims prior to billing
Collaborate with billing teams to ensure EVV data flows correctly into claim systems
Support resubmission and correction of EVV denied claims when appropriate
Analyze EVV denials and trends across all states
Determine root causes (system, workflow, staff, authorization, or compliance)
Create standard correction workflows for common EVV denial types
Track resolution outcomes and recovery rates
Escalate systemic issues and recommend process improvements
Develop standardized job aids, checklists, and reference guides
Continuously improve EVV workflows based on performance data
Train state-level staff on EVV best practices
Coach and support staff to achieve higher EVV compliance and clean-claim rates
Provide regular reporting and insights to leadership
Additional tasks and responsibilities may be assigned