Job Title: Home Health Billing Specialist
Job Location: Mt Juliet, Spring Hill or Cookeville
Job Status: Full - Time
POSITION SUMMARY: The Billing Specialist is responsible for performing all billing functions for the agency, ensuring claims are submitted accurately and on time to all payers. This role is crucial for revenue cycle success and requires deep knowledge of complex home health and hospice billing rules.
ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:
Conduct thorough pre-billing audits to verify patient eligibility, authorization validity, and documentation completeness before claim submission.
Prepare, review, and prepare claims (e.g., UB-04s/CMS-1450s) to Medicare, Medicaid, and all commercial insurance carriers for electronic submission.
Ensure the correct use of ICD-10 diagnosis codes and revenue codes on all claims to comply with payer requirements and minimize claim rejections.
Work closely with the Collections team (or perform initial follow-up) on accounts where payment has been delayed, short-paid, or denied, providing necessary documentation to facilitate recovery.
Communicate effectively with the accounting department regarding cash receipts, month-end closing procedures, and reporting on key billing metrics.
Stay current on all federal and state regulations, including the Patient-Driven Groupings Model (PDGM) for Home Health and the Hospice payment rates, ensuring claims reflect the latest changes.
Other appropriate services and special projects as assigned.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
QUALIFICATIONS & REQUIREMENTS FOR THE POSITION:
At least two (2) years of dedicated experience in medical billing and claims submission, with a strong preference for experience in home health or hospice billing.
Proven ability to submit and manage claims to Medicare, Medicaid, and commercial insurance.
Proficiency in navigating an Electronic Medical Record (EMR) and billing system and utilizing clearinghouses for electronic claim submission.
Solid working knowledge of ICD-10, CPT, and revenue codes as they relate to home health and hospice services.
PREFERRED KNOWLEDGE AND SKILLS:
Formal training or certification in Medical Billing and Coding (e.g., CPC, COC, CPB).
Experience with claims reconciliation and denial resolution.
Exceptional attention to detail and a commitment to 100% claim accuracy.
Strong analytical and mathematical skills for reconciliation and payment posting.
Excellent organizational skills and the ability to manage high-volume submission deadlines.
Proactive and persistent approach to resolving billing edits and rejections.
Strong ethical commitment to compliance and accurate financial reporting.
SUPERVISORY RESPONSIBILITIES:
PHYSICAL DEMANDS AND WORK ENVIRONMENT:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job may be performed at a desk and require heavy use of office equipment, including computer, tablet, and phone.
Must have the reasonable ability to stand, walk, sit, use hands to finger, handle, feel, reach, balance, see, talk, hear, and drive. Must be reasonably capable of lifting over twenty (20) pounds.
Minimal portion (<20%) of daily assignments may require travel to client/resident/patient locations or other work sites, via car or public transportation.
Work schedule may occasionally require evening, night, holiday, or weekend assignments.
I have read this job description and fully understand the requirements and notices set forth therein. I hereby accept the position and agree to perform the identified essential functions in a safe manner and in accordance with the Company’s established policies and procedures. I agree to request guidance from my Supervisor if I am unsure of how to interpret any policy.
I further understand that my employment is at-will and thereby understand that my employment may be terminated at-will either by the Company or myself, and that such termination can be made with or without notice.
This position consistently supports and promotes compliance with the Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the agency, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local laws and regulations, accreditation and licensure requirements (if applicable), and all policies and procedures.
