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Claims Specialist EVV, Medicaid Waivers & Authorizations
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Millie’s Home Health Care
Chester, VA (In Person)
$45,375 Salary, Full-Time
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Job Description
Position Summary We are seeking an experienced Claims Specialist to manage the billing and claims process for a home care agency serving individuals receiving Medicaid waiver services. The Claims Specialist will be responsible for ensuring accurate EVV compliance, verifying authorizations, submitting claims, resolving denials, and maintaining compliance with Virginia Medicaid and managed care organization (MCO) requirements. Key Responsibilities Claims Management Submit and monitor Medicaid, Medicare, and MCO claims. Review claims for accuracy prior to submission. Resolve claim denials, rejections, and payment discrepancies. Reprocess corrected claims and track payment status. Maintain aging reports and follow up on outstanding claims. EVV Compliance Audit Electronic Visit Verification (EVV) records for completeness and accuracy. Investigate missing, incomplete, or mismatched EVV visits. Collaborate with caregivers and schedulers to correct EVV exceptions. Ensure EVV records support billed services. Authorizations & Medicaid Waivers Verify service authorizations before billing. Track authorization periods and approved units. Monitor utilization to prevent overbilling or service interruptions. Work with care coordinators and managed care organizations regarding authorization issues. Assist with renewals and authorization corrections. Virginia Medicaid & DMAS Billing Submit claims through approved DMAS billing systems. Ensure compliance with Virginia Medicaid regulations and waiver requirements. Review remittance advice (RA) and explanation of benefits (EOBs). Research billing issues related to CCC Plus, DD Waiver, and other Medicaid programs. Maintain accurate payer information and eligibility records. Reporting & Documentation Maintain detailed documentation of claim activity. Generate weekly billing and collections reports. Assist with internal and external audits. Ensure compliance with HIPAA and agency policies. QualificationsRequired High School Diploma or GED. Minimum 2 years of medical billing or claims processing experience. Experience with Medicaid and managed care claims. Knowledge of EVV systems. Strong attention to detail and organizational skills. Proficiency with Microsoft Excel and billing software. Preferred Experience with Virginia DMAS billing. Experience with DD Waiver, CCC Plus Waiver, and Home Health or Personal Care services. Knowledge of payer portals including Medicaid MCOs such as Humana, Anthem, Sentara Health Plans, and UnitedHealthcare. Experience with healthcare revenue cycle management.