Healthcare Payor Change/ Reverification Representative

As a Healthcare Payor Change/Reverification Representative, you will report directly to the Payor Change/Reverification Supervisor. Shift/Availability Requirements Full time 40 hours a week scheduled for 8 hour shifts, 5 days a week. The schedule is Monday‑Friday from 8am‑5pm CST or 8:30am‑5:30pm CST. Responsibilities Daily auditing of admission, discharge and other source documentation to ensure revenue is recognized appropriately and all conditions of payment are met. Monitoring and reviewing weekly reverification runs for Medicare and Non‑Medicare. Verifying patient eligibility and payor coverage guidelines to ensure that all necessary information is secured for timely, accurate revenue recognition. Weekly generation of site revenue and resolution of batch errors and bill holds as appropriate. Weekly communication with site leadership detailing outstanding documentation or other issues resulting in a potential loss of revenue. Preparing and submitting invoices to Accounts Payable for reimbursement and performing follow up to ensure accurate, timely payments are made to our facility partners. Coordinating, reviewing, and analyzing documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing. Ensuring all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements. Ensuring all payer requirements are met accordingly, including pre‑cert requirements, notification requirements, and level of care change required documents. Alerting appropriate team members at the Site regarding late or missing documents required for billing. Establishing and maintaining positive working relationships with Sites, Nursing Home Facilities, and AR Teams. Maintaining the confidentiality of patient/client and agency information at all times. Maintaining accurate and up to date information for all vendor and nursing facility contracts. Keeping information in an orderly manner readily accessible for review. Presenting status as requested. Assuring compliance with local, state and federal laws, Medicare regulations, and established company policies and procedures. Acting as an information resource for any hard revenue generation issues or system issues. Assuring the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards. Required Qualifications 1 or more years of accounts receivable insurance claims experience. 1 or more years of eligibility experience. Proficient in using computers and Microsoft Office applications, including Word, Excel, Outlook and Teams. Preferred Qualifications Associate’s degree. 1 or more years of payor alignment experience. 1 or more years of insurance reverification experience. Home / Hybrid Requirements At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range $43,000 - $56,200 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options #J-18808-Ljbffr Humana Inc