Humana · 1 day ago
Director of Home Health Authorizations, Eligibility & Payor Maintenance
United States
Full-time
Remote
Senior Level, Lead/Staff
$115K/yr - $158K/yr
8+ years expHumana is a leading healthcare company specializing in home health services, and they are seeking a Director of Home Health Authorizations, Eligibility & Payor Maintenance. This role is responsible for the strategic oversight and operational execution of authorization and eligibility processes to ensure revenue integrity and patient access in a complex home health organization.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Develop and execute a comprehensive authorization, eligibility reverification 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
Direct day-to-day authorization, eligibility reverification 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
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
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
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
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
Qualification
Required
Bachelor's degree in Healthcare Administration, Business, Nursing, or related field required
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
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
Master's degree (MHA, MBA, MSN, or similar) preferred
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
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-06
2026-01-04
Fierce Healthcare
2025-12-24
Company data provided by crunchbase