RCM Insurance Follow Up Representative - Home Care

• Full-time Monday - Friday 9a - 5p - ONSITE/IN OFFICE
• $60k - $65k salaried position
• Must have prior experience in full cycle RCM (from the Payor side) within Home Healthcare/Hospital Systems preferred
• Must be able to work independently and with a team

Job Summary:

Vitasya Healthcare Consultants, LLC is seeking an RCM Insurance Follow Up Representative to manage a portfolio of accounts within client partners’ Government and Commercial Accounts Receivable in a home health care environment. This role is integral to the end-to-end revenue cycle, with a strong focus on resolving unpaid home health claims and optimizing reimbursement. This position is responsible for the timely, compliant, and insurance-centered resolution of outstanding accounts, ensuring proper documentation for home health-specific billing. The RCM Insurance Follow-up Representative plays a key role in denial management, underpayment recovery, and accounts receivable (A/R) reduction, supporting overall agency financial performance. Key Responsibilities:

• Perform comprehensive follow-up on assigned insurance accounts via payer portals, clearinghouses, and outbound calls to ensure timely resolution and reimbursement for home health services
• Analyze payer reimbursement methodologies specific to home health (e.g., Patient-Driven Groupings Model - PDGM, episodic rates, and fee for service)
• Identify, investigate, and resolve home health denials and underpayments; implement strategies to prevent recurring issues
• Prepare and submit/re-submit claims with a high degree of accuracy, ensuring proper coding (HCPCS, ICD-10), documentation, and compliance with home health billing requirements
• Collaborate with payers and internal departments (e.g., clinical, coding, intake) to resolve eligibility, authorization, and homebound status issues
• Manage claim inventory, including electronic and manual submission processes, while adhering to timely filing guidelines
• Maintain accurate, audit-ready documentation of all account activity within client systems and workflow tools

Required Skills & Qualifications:

• Strong knowledge of home health billing practices and claim forms (CMS-1500)
• In-depth understanding of the home health revenue cycle, particularly insurance follow-up and denial resolution
• Familiarity with home health payer guidelines, reimbursement structures (PDGM), and managed care contracts
• Ability to navigate multiple systems (EHR, billing platforms, payer portals) with efficiency and accuracy
• Excellent written and verbal communication skills, including experience handling payer escalations regarding home health authorizations
• Strong attention to detail, analytical thinking, and problem-solving abilities
• Patient-focused mindset with an understanding of the financial patient experience and home health care delivery

Preferred Qualifications:

• Experience working with Medicare (including Home Health Agencies - HHAs), Medicaid, and commercial payers in a home health or hospice setting
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
• Knowledge of HIPAA and healthcare compliance regulations
• Proven ability to collaborate effectively with cross-functional teams and clinical leadership

#VHC1

Pay: $60,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• Medical Revenue Cycle: 5 years (Required)
• Medicaid Billing: 5 years (Required)
• Medical Collection: 5 years (Required)
• Hospital Billing: 2 years (Preferred)
• Homecare: 2 years (Preferred)
• AR/AR Follow up: 5 years (Required)

Work Location: In person