Healthcare Operations and Revenue Cycle Virtual Assistant

Position Overview
The Healthcare Operations and Revenue Cycle Virtual Assistant will support EVV reconciliation, billing and claim resolution, private-pay accounts receivable, payer enrollment and claims-platform administration, referral intake, eligibility and authorization tracking, documentation quality, scheduling, patient communication, recruitment, credentialing, management reporting, referral outreach, and general administration. This is an administrative position and does not include independent clinical judgment or licensed nursing practice.

Key Responsibilities
• EVV monitoring and reconciliation Review Alora and Sandata exceptions, identify missing clock-ins or clock-outs, compare scheduled and verified hours, contact caregivers for supported corrections, and prepare daily exception reports.
• Billing, denial resolution, and accounts receivable Reconcile authorized hours, EVV, service documentation, and claims; prepare claims and post remittances. Investigate denied, rejected, underpaid, and unpaid claims; identify errors involving patient or payer data, provider information, service codes, modifiers, units, dates, authorizations, EVV, documentation, timely filing, or submission format; and correct administrative errors or coordinate corrections with the responsible team member. Contact and follow up with the Ohio Department of Medicaid (ODM), Medicaid managed-care plans, commercial insurers, and other payers; record denial reasons, payer reference numbers, actions, and next follow-up dates; submit corrected claims or prepare reconsiderations and appeals under approved procedures; and verify acceptance, adjudication, and payment through resolution or escalation.
• Private-pay invoice follow-up Reconcile invoices, statements, and payments; professionally contact private-pay clients or authorized responsible parties regarding delayed or unpaid invoices; resend statements; resolve routine administrative discrepancies; document communications and payment commitments; and escalate disputes, hardship requests, payment arrangements, refunds, write-offs, or high-value balances for approval.
• Payer enrollment and claims-platform administration Maintain accurate enrollment, linkage, access, and organization records in ODM PNM, Medicaid managed-care and commercial payer portals, clearinghouses, EFT and ERA systems, and claims-submission and remittance platforms. Track applications, corrections, revalidations, renewals, rosters, service locations, NPI and taxonomy data, contacts, W-9 and legal-entity information, and required documents through completion. Verify that Peniel can submit claims, receive remittance information, and receive payment; promptly escalate access, enrollment, linkage, or payment-routing problems.
• Referral intake Monitor CarePort, email, fax, and other approved referral portals. Collect demographics, insurance information, service needs, and required documents; request missing items; update referral status; and coordinate prompt routing for acceptance review.
• Eligibility and authorization tracking Verify coverage through approved portals, record verification details, track authorization periods and units, maintain ISP and plan-of-care checklists, and alert management before expirations, shortages, or renewal deadlines.
• Documentation quality assurance Check records for required fields, dates, signatures, service descriptions, start and stop times, units, and alignment with the ISP or plan of care. Request completion from caregivers and assemble organized audit packets.
• Scheduling administration Confirm shifts, maintain caregiver availability, notify preapproved caregivers of openings, send reminders, document call-offs, and maintain records of coverage attempts and schedule changes.
• Patient and family communication Complete introductory and routine status calls, send appointment reminders, conduct approved scripted satisfaction surveys, document nonclinical requests, and route concerns to the appropriate Peniel leader.
• Recruitment and HR administration Post approved openings, screen candidates against objective criteria, schedule interviews, collect onboarding documents, and track training, background checks, credentials, and expiration dates.
• Credentialing administration Maintain renewal calendars, compile credentialing applications, update rosters, collect supporting documents, and track submissions and follow-up items through completion.
• Quality and management reporting Prepare dashboards covering census, referral conversion, uncovered shifts, service utilization, authorization balances, claim denials, payer and private-pay aging, payer-enrollment status, overtime, documentation status, and caregiver retention.
• Marketing and referral outreach Maintain the referral-source CRM, identify hospitals, county boards, managed-care plans, veterans' organizations, and community partners, prepare non-PHI outreach, schedule meetings, track follow-up, and update approved social-media content.
• General administration Support inbox management, meeting scheduling, SOP formatting, vendor follow-up, invoice tracking, action lists, and organized electronic records so owners and local leaders can focus on growth, patient care, and oversight.

Required Qualifications
• At least two years of recent experience supporting a U.S. healthcare, home care, home health, medical billing, revenue-cycle, or patient-access organization.
• Hands-on experience with U.S. healthcare billing, denial resolution, corrected-claim submission, payer follow-up, and accounts receivable, including professional follow-up on past-due private-pay invoices.
• Experience maintaining payer enrollments or provider records in Medicaid, managed-care, commercial insurance, clearinghouse, claims, remittance, EFT, or ERA platforms, plus at least two of these areas: EVV management, eligibility verification, prior authorization, referral intake, scheduling, credentialing, recruitment administration, or medical-record quality review.
• Working knowledge of HIPAA, protected health information, secure communication, and minimum-necessary access.
• Strong Microsoft Excel skills and the ability to maintain accurate trackers, aging reports, dashboards, calendars, and CRM records while reconciling information from multiple systems.
• Professional spoken and written English, excellent attention to detail, sound judgment, reliable follow-through, and willingness to escalate rather than guess.
• Ability to work the stated U.S. Eastern Time schedule consistently, including overnight hours in the Philippines.