Revenue Cycle & Claims Resolution Specialist

AW Health Care•University City, MO

About The Position

Looking for a Job You Love—and More Time with Your Family? AW Health Care is currently seeking a full-time Revenue Cycle & Claims Resolution Specialist for our Home Health team. The position can will be located in one of our convenient office locations throughout the Metro St Louis area based on the most qualified candidate's preferred location. With a flexible schedule, excellent clinical outcomes, and strong patient satisfaction, this role is designed for professionals who want to make a difference—without sacrificing personal time. About AW Health Care: AW Health Care is a woman-owned, independent home health agency based in St. Louis, proudly serving Missouri and Illinois for over 25 years. With more than 500 team members supporting over 1,500 patients, we are committed to delivering innovative, patient-centered care that makes a difference. The Revenue Cycle & Claim Resolution Specialist is responsible for verifying insurance coverage, obtaining and managing prior authorizations, and supporting accurate billing for home health services, with a primary focus on Medicare, Medicaid and Medicare Advantage plans. This role works closely with intake, clinical, scheduling, and billing teams to ensure timely start of care, compliance with payer requirements, and appropriate reimbursement.

Requirements

3+ years of experience in insurance verification, Medicare Advantage authorizations, or billing
Strong knowledge of Medicare Advantage home health authorization processes
Experience working with EMR systems and payer portals
High attention to detail and strong organizational skills

Nice To Haves

Associate’s degree or certification in medical billing, coding, or healthcare administration
Experience with home health EMRs
Familiarity with Medicare Advantage UM vendors and payer portals (e.g., Availity, Carelon, Essence, UHC, & Waystar)
Understanding of OASIS, PDGM, iQIES, ICD-10, CPT, and HCPCS codes
Ability to manage high-volume Medicare Advantage authorizations
Strong follow-up and time-management skills
Problem-solving and denial resolution experience
Ability to work independently in a fast-paced home health environment
Excellent written and verbal communication skills
Timely completion of eligibility verification and authorizations
Accurate documentation supporting clean claims and reduced denials
Consistent collaboration with clinical and billing teams

Responsibilities

Verify patient eligibility, benefits, and coverage for home health services
Confirm plan type (Traditional Medicare vs. Medicare Advantage) and identify delegated UM entities
Review benefits for visit limits, authorization requirements, and covered disciplines (SN, PT, OT, ST, HHA, MSW)
Communicate eligibility findings and restrictions to clients, intake and clinical teams
Document all verification details accurately in EMR and billing systems
Escalate coverage discrepancies to intake leadership as needed
Obtain initial, ongoing, and recertification authorizations for Medicare Advantage patients
Submit clinical documentation (OASIS, therapy evaluations, visit plans, physician orders) per payer guidelines
Track authorization timelines and proactively follow up to prevent delays or interruptions in care
Notify teams of approvals, partial approvals, denials, and changes to authorized visit counts
Ensure authorization data aligns with scheduled visits and services rendered
Review billing information for accuracy prior to claim submission
Support timely claim submission to Medicare Advantage payers and delegated UM entities
Track denial trends and report to leadership
Assist with resolving claim denials, underpayments, and authorization-related billing issues
Maintain accurate documentation in the EMR and billing systems to support compliant reimbursement
Ensure adherence to Medicare Conditions of Participation and Medicare Advantage payer requirements
Stay current on Medicare Advantage policies, authorization rules, and documentation standards
Serve as a liaison between home health agency staff and insurance payers/UM vendors
Collaborate with intake, case management, therapy, scheduling, and billing teams to ensure continuity of care
Provide clear, timely communication regarding authorization status and payer requirements

Benefits

Medical, Dental, and Life Insurance
401(k) with Company Match of 4%
Paid Time Off (PTO)
Supplemental benefits (Short/Long-Term Disability, AD&D, Additional Life Insurance)

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