Billing & Authorization Specialist - Medical & Home Care

Job Description

Job Description

Billing & Authorization Specialist – Medical & Home Care

In Home Wellcare – Providence, RI

In Home Wellcare, a licensed home care agency in Rhode Island, is growing quickly and we’re looking for the right person to join our team. This is a great opportunity for someone with billing experience who wants to be part of a mission-driven company, get exposure to both home care and medical billing, and grow with a supportive team. We also offer same-day pay to make things easier for our employees.

This is an on-site position, not remote. It’s best suited for someone with billing experience who’s ready to take their skills to the next level in a collaborative office setting.

Position Summary

The Billing & Authorization Specialist plays a key role in daily billing operations, verifying authorizations, tracking insurance changes, and submitting claims. Because clients can change coverage without notice, daily billing and eligibility checks are essential to prevent service interruptions.

You’ll be working with:

• Axxess – caregiver EVV/time tracking
• Inovalon – clearinghouse/claims
• NaviNet & RI Medicaid Provider Portal – eligibility and authorizations

Sunday billing is required to meet submission deadlines, with flexibility during the week to balance the workload.

Key Responsibilities

• Daily Billing & Issue Tracking – Submit claims, monitor denials, rebill as needed.
• EVV Oversight – Monitor caregiver clock-ins through Axxess for accuracy and compliance.
• Authorization Management – Track, request, and verify prior authorizations.
• Claims Submission – Use Inovalon to submit/manage claims, monitor rejections and updates.
• Insurance Verification – Run daily eligibility checks in NaviNet and RI Medicaid Provider Portal.
• Billing Code Accuracy – Use correct HCPCS codes and modifiers (S5125 – Home Care, S5130 – Homemaker, T1001 – Nurse Visit, plus modifiers UH, UJ, TV, U1).

Qualifications

• Direct experience with medical or home care billing and authorization workflows.
• Proficiency in Axxess, Inovalon, NaviNet, and RI Provider Portal.
• Strong attention to detail and follow-up.
• Available Sundays to meet 8 PM billing deadlines.
• Must work on-site (not remote).
• Bilingual (Spanish/English) strongly preferred.

What We Offer

• Same-day pay
• Medical coverage available
• A welcoming and inclusive workplace
• Opportunities to grow with a fast-paced, mission-driven healthcare company

Our Mission, Vision & Values

• Mission – Provide compassionate, innovative, and culturally sensitive care.
• Vision – To be a guiding light for those in need, offering care that feels like home.
• Values – Compassion · Innovation · Diversity · Integrity · Collaboration · Excellence · Client-Centered Service