Revenue Cycle & Credentialing Specialist

About HomeWell Care Services At HomeWell Care Services FL263, we are committed to delivering high-quality care that allows our clients to live independently and comfortably in their own homes. We are expanding our team and looking for dedicated professionals who want to make a meaningful impact while growing their careers with us. Position Overview We are seeking an experienced, detail-oriented Revenue Cycle & Credentialing Specialist to join our administrative team. In this role, you will take full ownership of our insurance credentialing, provider enrollment, billing, claims management, and overall revenue cycle operations. Your expertise will ensure timely payer enrollment, accurate claim submissions, rapid reimbursement, and strict compliance with Florida Medicaid and managed care requirements. If you are a self-motivated professional with deep experience in Florida healthcare reimbursement, we want to hear from you. Why Join Us? Flexibility: Productive hybrid or fully remote work options. Growth: Be a key player in a rapidly growing healthcare organization. Support: A collaborative management team focused on your professional success. Benefits: [Insert Benefits Here, e.g., Health, Vision, PTO, 401k - Highly recommended for CareerPlug visibility ] Essential Duties & Responsibilities Credentialing & Provider Enrollment Prepare and submit accurate provider enrollment and credentialing applications to Florida Medicaid and Managed Care Organizations (MCOs). Proactively monitor and track application statuses from initial submission through final approval. Organize and maintain all credentialing files, payer contracts, and official documentation. Coordinate and execute re-credentialing processes well ahead of expiration deadlines. Insurance Billing & Claims Management Oversee daily electronic claims submissions and verify accuracy prior to transmission. Research, correct, and resubmit rejected claims, and draft effective appeals when necessary. Monitor outstanding unpaid claims and maintain consistent communication with insurance representatives. Accurately post payments and process necessary claim corrections within the billing system. Revenue Cycle Optimization & Compliance Track accounts receivable (A/R) to identify trends, reduce outstanding balances, and improve overall collection rates. Prepare and deliver clear monthly billing and financial reports for the management team. Maintain strict HIPAA compliance and adhere to all regulatory payer and state guidelines. Assist management and external auditors during administrative or financial reviews. Job Requirements (Qualifications) Required: Experience: Minimum 3 years of medical billing AND 2 years of provider credentialing experience. Regional Knowledge: Deep familiarity with Florida Medicaid regulations and Managed Care Organizations (MCOs). Technical Skills: Hands-on experience with electronic claims submission platforms. Communication: Excellent written and verbal communication skills to successfully navigate insurance provider networks. Core Traits: Highly organized, detail-oriented, and capable of managing workloads independently. Preferred (Highly Valued): Industry Background: Prior experience in home care or home health settings. Software Proficiency: Experience using WellSky , Availity , and the FL MMIS portal. Payer Programs: Familiarity with Medicare billing protocols. Performance Expectations & Success Metrics First 90-Day Milestones: 30 Days: Complete onboarding, learn HomeWell workflows, and audit current Medicaid/payer enrollments. 60 Days: Clear pending credentialing applications and begin managing the billing cycle independently. 90 Days: Fully own the billing and credentialing processes while successfully reducing claim denials. Key Performance Indicators (KPIs): Submit credentialing applications within 5 business days of receipt. Transmit electronic claims within 48 hours of service completion. Maintain a claim acceptance rate of 95% or higher and a denial rate below 5% . Keep Accounts Receivable (A/R) under 45 days . Deliver monthly financial reporting by the 5th business day of each month. Flexible work from home options available. An Industry-Leading, Nation-Wide Team At HomeWell Care Services, we pride ourselves on providing the highest quality care for seniors and others needing individualized support and companionship at home. With locations across the U.S., we offer many opportunities for compassionate individuals who enjoy improving the quality of life of those around them, with numerous positions for varying levels of expertise, such as companion caregivers, certified aides and case managers. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to HomeWell Care Service Corporate.