Revenue Cycle & Claims Resolution Specialist

Job Overview

AW Health Care is seeking a full-time Revenue Cycle & Claims Resolution Specialist for our Home Health team. The position can 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 and strong patient satisfaction, this role is designed for professionals who want to make a difference—without sacrificing personal time.

AW Health Care is a woman-owned, independent home health agency based in St. Louis, 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.

• 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)

The Revenue Cycle & Claim Resolution Specialist verifies insurance coverage, obtains and manages prior authorizations, and supports accurate billing for home health services, focusing on Medicare, Medicaid, and Medicare Advantage plans. The role works closely with intake, clinical, scheduling, and billing teams to ensure timely start of care, compliance with payer requirements, and appropriate reimbursement.

• 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