Job Title: Home Health Agency Administrator

Location: Miami, FL (In-Office / Local Oversight Required)

Job Type: Full-Time or Part-Time

Salary: Competitive Salary (Commensurate with experience; to be discussed)

Job Description

We are seeking a highly organized, leadership-driven, and compliance-minded Home Health Administrator to oversee the daily operations, provider relationships, and regulatory standing of our Miami-based home health agency.

In this role, you will serve as the primary operational leader, ensuring our agency delivers exceptional, high-quality care to patients in their homes while remaining in strict alignment with state, federal, and commercial insurance requirements. The ideal candidate possesses a deep understanding of home care operations, excels at clinical personnel management, and is skilled at navigating insurance networks and the prior authorization process to ensure seamless care delivery.

Key Responsibilities

Insurance, Managed Care & Plan Coordination

• Payer Eligibility Verification: Oversee the verification of patient insurance eligibility, benefits coverage, and network participation across private commercial insurances, Medicare Advantage, and managed care plans.
• Prior Authorization Management: Coordinate the collection and submission of clinical documentation to secure required prior authorizations, concurrent reviews, and re-authorizations before services are rendered.
• Denial Management & Appeals: Review authorization trends, identify gaps in submitted documentation, and directly handle communication or appeals with insurance providers regarding service denials or coverage limitations.
• Payer Compliance: Ensure that the quantity, frequency, and type of home care services provided strictly match the approved parameters of individual payer care plans.

Regulatory Compliance & Quality Assurance

• AHCA & Federal Alignment: Maintain total operational compliance with the Florida Agency for Health Care Administration (AHCA) regulations, federal Conditions of Participation (CoPs), and HIPAA privacy laws.
• Audit & Survey Readiness: Lead the agency's preparation for unannounced state inspections, clinical audits, and regulatory surveys, serving as the primary point of contact for external inspectors.

Staff Management & Operational Oversight

• Personnel Management: Recruit, onboard, evaluate, and retain clinical and administrative personnel, including nursing supervisors, coordinators, field nurses, and Home Health Aides (HHAs).
• Credentialing & Staff Compliance: Ensure all personnel files are completely up-to-date with verified professional Florida licensures, mandatory AHCA Level 2 background screenings, and continuing education credits.
• Intake & Scheduling: Oversee daily patient intake logistics and case assignments, ensuring clinical schedules match patient needs safely and efficiently.

Community & Provider Relations

• Referral Network Cultivation: Build and cultivate trusted professional relationships with local clinical providers, hospitals, case managers, and discharge planners to manage and grow client census.

Qualifications & Requirements

• Education: Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, or a closely related field preferred.
• Experience: Minimum of 3 to 5 years of experience in home health care operations, with at least 2 years in an administrative, supervisory, or management role.
• Insurance Acumen: Proven experience working directly with health insurance networks, managed care portals, and securing prior authorizations for home health services.
• Regulatory Knowledge: Deep understanding of Florida AHCA home health agency regulations and state survey processes.
• Licensure (Preferred): Active, unencumbered Registered Nurse (RN) license in the state of Florida is highly preferred but not mandatory if administrative and insurance experience is strong.
• Skills:
• Exceptional written and verbal communication skills for interfacing with insurance representatives, clinicians, and families.
• Proficiency with Electronic Medical Record (EMR) systems and major insurance provider web portals.
• Bilingual proficiency (English/Spanish) is a major asset in the Miami market.

Benefits

• Flexible schedule options (Full-Time or Part-Time).
• Paid Time Off (PTO) and holiday pay.
• Professional development and growth opportunities within a scaling agency.

Benefits:

• Paid time off

Work Location: In person