Medicaid Biller & Authorization Specialist

Job Description

Job Description

Description:

Description

Who We Are

Frontier Home Health provides exceptional home healthcare services in Pueblo, El Paso, and Fremont counties in Colorado. We are committed to delivering high-quality patient care, fostering strong community relationships, and maintaining a positive staff culture while adhering to the highest compliance standards. Collaborating with physicians, hospitals, and care facilities, we provide comprehensive support and enhance the quality of life for our patients. Recognized locally in Pueblo as a top home healthcare agency in 2025, we take pride in making a meaningful impact in the communities we serve.

We are seeking an experienced, detail-oriented Biller and Authorization Specialist based in Colorado to manage our specialized billing and prior authorization workflows. In this role, you will play a critical part in streamlining agency workflows, establishing complete visibility into our billing processes, and ensuring seamless revenue cycle management.

The ideal candidate possesses deep expertise in navigating Health First Colorado (Colorado Medicaid), In-Home Support Services (IHSS), and TRICARE guidelines. You will be responsible for securing timely authorizations, preventing denials, and accurately processing claims while maintaining a high level of accountability, integrity, and passion for compliance.

• Authorization Management: Initiate, track, and secure timely prior authorizations and re-authorizations for Colorado Medicaid (PARs), IHSS, and TRICARE services; proactively manage expiration dates to prevent gaps in client care.
• Claims & Billing Process: Prepare, review, and submit clean electronic claims through the Colorado interChange (Provider Web Portal) and TRICARE West portals; audit billing codes, modifiers, and documentation to ensure accuracy before submission.
• Denial & Appeal Resolution: Identify, analyze, and resolve claim rejections and denials; draft and submit formal appeals with necessary medical necessity documentation.
• Workflow Visibility & Tracking: Utilize automated tracking tools to monitor weekly operational billing data and report on aging accounts receivable, authorization timelines, and collection trends.
• Compliance & Policy Auditing: Stay continuously updated on evolving Colorado Department of Health Care Policy and Financing (HCPF) regulations and federal TRICARE guidelines to ensure all billing practices strictly align with compliance standards.
• Cross-Functional Collaboration: Partner closely with clinical coordinators, intake teams, and administrative leadership to resolve documentation discrepancies and optimize the overall revenue cycle workflow.

• Experience: Minimum of 2–3 years of direct experience in medical billing and prior authorizations, specifically working with Health First Colorado (Medicaid), IHSS, and TRICARE protocols.
• Systems Proficiency: Strong experience with Electronic Health Records (EHR) software, clearinghouses, and the Colorado Medicaid Provider Web Portal. Highly proficient in using data tools (like Excel or tracking dashboards) to manage and carry over weekly trending data.
• Knowledge Base: Expert understanding of ICD-10, CPT, and HCPCS coding, as well as specific documentation requirements for Colorado home health, IHSS, or CDASS care models.
• Attributes: Exceptional attention to detail, highly organized, and an analytical mindset capable of troubleshooting complex billing issues independently.

We are looking for a professional who naturally embodies our foundational values in their daily work:

• Integrity & Accountability: Doing what is right for our agency and clients, and taking ownership of the accuracy of your portfolio.
• Attentive & Passionate: Demonstrating a high level of focus on intricate guidelines and a genuine passion for supporting the healthcare ecosystem.
• Quality & Evolve: Committing to error-free work while actively looking for ways to adapt, learn, and streamline operational workflows.

• Hourly/Salary Range: $23.00-25.00 per hour / annually (Dependent on experience). Certifications could increase the salary range.
• Benefits: We offer a comprehensive benefits package including health, dental, and vision insurance, a 401(k) plan with company match, paid time off (PTO), and paid holidays.]