What are the responsibilities and job description for the Billing Specialist position at Canyon Home Care & Hospice LLC?
We are seeking an experienced and detail-oriented Home Health & Hospice Medical Biller to join our Revenue Cycle team. In this critical role, you will be responsible for the accurate and timely submission of claims to Medicare, Medicaid, and private insurance payers for home health and hospice services. The ideal candidate brings a solid understanding of home health and hospice billing regulations, payer-specific requirements, and a commitment to compliance and clean claim submission
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- Prepare and submit accurate claims for home health (PPS/RAPs/Final Claims) and hospice services (NOE, election, revocation, and final claims) to Medicare, Medicaid, and commercial insurers
- Process final claims in accordance with CMS timelines
- Review Explanation of Benefits (EOBs) and Remittance Advices (RAs); post payments and adjustments accurately
- Identify, work, and resolve claim denials, rejections, and underpayments through timely appeals and follow-up
- Verify patient eligibility, hospice election status, and benefit period information prior to billing
- Maintain working knowledge of OASIS assessments, physician orders, and their relationship to billing compliance
- Monitor accounts receivable aging reports and take proactive steps to reduce outstanding balances
- Communicate with clinical staff, coders, and intake coordinators to resolve billing discrepancies
- Ensure compliance with Medicare Conditions of Participation (CoPs), HIPAA regulations, and agency policies
- Stay current on CMS rule changes, LCD/NCD updates, and state Medicaid billing requirements
- Generate and analyze billing reports; present findings to management as needed
- Assist with internal and external audits as requested
Qualifications:
- Minimum 2 years of medical billing experience specifically in home health and/or hospice
- Strong knowledge of Medicare home health Prospective Payment System (PPS), PDGM, and hospice benefit billing
- Proficiency with EMR/billing software (e.g., Kinnser, WellSky, Homecare Homebase, MatrixCare, or similar)
- Familiarity with UB-04 claim forms and electronic claim submission via clearinghouses (e.g. Waystar, Change Healthcare)
- Knowledge of HIPAA privacy and security regulations
- Strong attention to detail and organizational skills
- Certified Professional Biller (CPS), Certified Medical Reimbursement Specialist (CMRS), or equivalent credential
- Experience billing Medicaid waiver programs or managed care/Medicare Advantage plans
- Familiarity with Value-Based Purchasing (VBP) programs in home health