Convenient Home Health Agency- 77063

Job Title: Home Healthcare Coordinator

Role Summary

The Home Healthcare Coordinator serves as the primary link between patients, their families, and the multidisciplinary care team. This role is responsible for managing the transition from clinical care to home-based services, ensuring high-quality, continuous care while maintaining strict clinical and financial compliance.

Key Responsibilities

Pre-Claim Review (PCR) Management: Lead the Pre-Claim Review (PCR) submission process to ensure all required documentation is submitted to Medicare (or relevant MACs) accurately and timely to avoid payment delays or denials.

Insurance Verification & Eligibility: Perform comprehensive insurance verification and check eligibility for all patients; coordinate with payers to secure necessary authorizations before the start of care.

Clinical Data Entry & Compliance: Utilize Oasis for patient assessments and data collection, ensuring that all clinical documentation supports the medical necessity required for PCR and insurance approvals.

Portal & Software Utilization: Navigate Availity and E-Services for claims management, eligibility checks, and authorization tracking.

Care Coordination: Schedule and manage home visits and clinician assignments using Kinnser (WellSky) to ensure the physician's plan of care is followed precisely.

Documentation Oversight: Review patient records for accuracy and completeness to meet state, federal, and insurance-specific regulatory standards.

Qualifications

Education: High School Diploma or equivalent required. An Associate’s or Bachelor’s degree in Healthcare Administration, Nursing, or a related field is preferred but not required.

Experience: 2+ years of experience in home health coordination, case management, or a similar administrative clinical role.

Technical Expertise: Direct, hands-on experience with Kinnser, Oasis, Availity, and E-Services is highly preferred.

Specialized Knowledge: Proven experience with Pre-Claim Review (PCR) workflows and Medicare home health eligibility requirements.

Certifications: Valid CPR certification preferred; state clinical licensure (e.g., LPN/LVN) is a plus but not mandatory.

Preferred Skills

Deep understanding of the Medicare Home Health Prospective Payment System (HH PPS) and documentation requirements.

Exceptional organizational skills with the ability to manage a high volume of PCR submissions and patient cases simultaneously.

Strong communication skills for interacting with physicians, insurance representatives, and patient families.