Director of Home Health Authorizations, Eligibility

Become a part of our caring community and help us put health first A Director of Authorizations & Eligibility is a senior revenue cycle leader responsible for the strategic oversight, operational execution, and continuous improvement of all authorization, insurance eligibility re-verification and payer maintenance for a large, complex Home Health organization operating on the Homecare Homebase (HCHB) platform. This role leads enterprise-wide authorization related operations supporting high-volume, multi-branch environments and ensures timely, compliant payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore and offshore teams. The role also leads transformational initiatives related to centralization, automation, scalability, and payer optimization. Key Responsibilities Strategic Leadership & Governance Develop and execute a comprehensive authorization, eligibility re-verification and payor encounter maintenance strategy aligned with enterprise revenue cycle objectives. Serve as the organizational subject-matter expert on payer authorization rules, revalidation requirements, and medical necessity workflows. Lead large-scale transformation initiatives including centralization, workflow redesign, automation, and performance standardization. Establish governance, escalation paths, and performance accountability across a complex, multi-site organization. Operational Oversight Direct day-to-day authorization, eligibility re-verification and payor encounter maintenance operations across all service lines and payers. Ensure timely and accurate submission, tracking, and renewal of authorizations in Homecare Homebase. Oversee management of payer portals, authorization queues, and work distribution. Ensure consistent execution across onshore and offshore teams. Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams. Clinical & Operational Collaboration Partner with nursing leadership, therapy leadership, and clinical staff to ensure clinical documentation supports medical necessity. Support resolution of clinical questions related to authorization determinations. Collaborate with Quality, Compliance, and Audit teams to support medical reviews and audits. Translate payer requirements into operational workflows and staff education. Performance Management & Analytics Define, monitor, and report KPIs including authorization turnaround time, authorization success rate, denial rate, and authorization-related delays. Use data to identify trends, root causes, and improvement opportunities. Present performance insights to executive leadership. Drive continuous improvement using Lean, Six Sigma, or similar methodologies. Compliance & Risk Management Ensure compliance with Medicare, Medicaid, and commercial payer authorization and revalidation requirements. Maintain audit-ready documentation and processes. Support external audits (MAC, SMRC, RAC, UPIC) and payer reviews related to authorization. Partner with Compliance and Legal teams on corrective action plans. People Leadership Lead, coach, and develop managers, supervisors, and frontline authorization staff. Manage blended onshore/offshore workforce models. Establish clear roles, performance expectations, and career pathways. Promote accountability, engagement, and operational excellence. Key Interfaces Branch Operational Staff and Leaders Clinical Operations Leadership (Nursing, Therapy, QA) Intake and Scheduling Teams Revenue Cycle Leadership Billing, Denials, and Appeals Teams Compliance, Legal, and Audit IT / Applications (Homecare Homebase) External Payers and Vendor Partners Use your skills to make an impact Requirements Education Bachelor’s degree in Healthcare Administration, Business, Nursing, or related field required. Master’s degree (MHA, MBA, MSN, or similar) preferred. Experience 8 or more years of progressive experience in healthcare revenue cycle or access operations. Minimum of 5 years leading authorization or insurance verification functions. Experience in large, complex, multi-site healthcare organizations. Demonstrated experience leading centralized and distributed (onshore/offshore) teams. Direct experience working with Homecare Homebase strongly preferred. Experience supporting Medicare, Medicare Advantage, Medicaid, and commercial payers. Proven success leading transformational or enterprise-scale process improvement initiatives. Skills & Competencies Deep knowledge of home health authorization, eligibility, and payer rules. Strong understanding of clinical workflows and medical necessity. Advanced operational and analytical skills. Ability to manage complexity, ambiguity, and change. Executive-level communication and influence skills. Strong collaboration across clinical, operational, and financial teams. Expertise in KPI-driven performance management. Preferred Certifications Certified Healthcare Access Manager (CHAM) Certified Revenue Cycle Professional (CRCP) Lean Six Sigma (Green Belt or higher) Project Management Professional (PMP) Nursing license (RN or LPN/LVN) preferred but not required Additional Information To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 – $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: About us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers — all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first — for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options #J-18808-Ljbffr