Job Details

EVV Compliance Specialist

Position Summary: The EVV Compliance Specialist is responsible for a variety of daily tasks related to managing the electronic visit verification (EVV) systems across multiple states. Tasks will include monitoring the EVV systems in real-time, communicating with caregivers, branch staff and insurance payers and working from Excel reports to reconcile data between multiple systems.

Knowledge of home care operations, including Horizon preferred

Knowledge of state Electronic Visit Verification (EVV) systems preferred

Schedule: Mon-Fri 8am-5pm (Remote)

We offer our team the best

• Medical, Dental and Vision Benefits
• Continued Education
• PTO Plan
• Retirement Planning
• Life Insurance
• Employee discounts

Essential Duties:

• Monitor EVV systems in real-time and contact caregivers who have not clocked in or out successfully, in order to understand the issue and request the paper timesheet. Follow processes for escalation when necessary
• Provide educational/training assistance to caregiver staff on appropriate use of the EVV systems in order to drive compliance
• Request retro schedule change requests and manual visit confirmation requests and follow up until resolved and billing is complete
• Work with insurance companies and EVV companies as necessary to resolve demographic and/or authorization issues within the EVV system
• Complete root cause research and resolve errors in EVV systems; resulting in accurate service hours and the correct billing of claims to payers
• Complete root cause research and resolve errors populating on Excel reports, resulting in information accurately importing into our system, the correct billing of claims to payers and our systems accurately reconciling
• Serve as subject matter expert on all EVV systems and provide training to others as needed.
• Serve as subject matter expert on rules surrounding billing in accordance to regulatory requirements set forth by payers, state, and federal agencies.
• Exhibit excellent interpersonal and communication skills necessary to interact with our customers and staff members in all departments and branches.
• Maintains positive working relationships with all other staff to gain their cooperation and support.
• Provide support in implementing improvements to processes and electronic information systems to ensure ongoing efficiency across the organization.
• Monitoring and trending EVV data to ensure procedures and processes are working properly.
• Providing support and assistance to Operations and/or Reimbursement departments as needed for specials projects or needs.
• Maintains a high degree of confidentiality at all times due to access to sensitive information
• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
• Follows all Medicare, Medicaid, and HIPAA regulations and requirements
• Abides by all regulations, policies, procedures and standards
• Performs other duties as assigned

Performance Responsibilities:

• Maintains positive internal and external customer service relationships
• Maintains open lines of communication
• Plans and organizes work effectively and ensures its completion
• Meets all productivity requirements
• Demonstrates team behavior and promotes a team-oriented environment
• Actively participates in continuous quality improvement
• Represents the organization professionally at all times

Position Requirements & Competencies:

• High school diploma or GED equivalent
• Administrative experience required; customer service experience preferred
• Strong communication skills and interpersonal skills
• Computer proficiency required; including intermediate level knowledge in Microsoft Excel
• Knowledge of home care operations, including Horizon preferred
• Knowledge of state Electronic Visit Verification (EVV) systems preferred
• Ability to work collaboratively and individually
• Analytical and problem solving skills required
• Ability to read, interpret and implement regulations and administrative rules from a variety of sources including the State and Federal government