HOME HEALTH & HOSPICE BILLER

POSITION SUMMARY

The Home Health & Hospice Biller is responsible for accurate and timely billing and reimbursement activities for Home Health and Hospice services. This position processes claims to Medicare, Medicaid, commercial insurance companies, managed care organizations, and other third-party payers. The Biller ensures claims are submitted accurately, follows up on unpaid and denied claims, researches billing discrepancies, and works to maintain timely reimbursement and a healthy accounts receivable balance.

The Home Health & Hospice Biller works closely with clinical, intake, authorization, coding, medical records, and accounting personnel to ensure services are properly documented, authorized, coded, billed, and reimbursed in accordance with payer requirements and applicable regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Billing and Claims Processing

·         Prepare and submit accurate Home Health and Hospice claims to Medicare, Medicaid, commercial insurance companies, managed care organizations, and other third-party payers.

·         Review patient accounts and billing information for accuracy prior to claim submission.

·         Verify patient demographics, insurance coverage, payer information, authorization requirements, and applicable benefit information.

·         Ensure claims are submitted within payer and regulatory timely filing requirements.

·         Review claims for missing or incorrect information that could result in rejection or denial.

·         Enter and maintain billing information accurately within the electronic medical record and/or billing system.

·         Process corrections, adjustments, rebills, and replacement claims as necessary.

·         Monitor electronic and paper claim submissions and resolve claim transmission errors.

·         Maintain knowledge of Home Health and Hospice billing requirements, including Medicare and Medicaid requirements.

·         Review billing reports to identify outstanding, rejected, or unbilled claims.

Accounts Receivable and Collections

·         Monitor accounts receivable and follow up on outstanding balances in a timely manner.

·         Review aging reports and prioritize accounts based on age, payer, balance, and likelihood of collection.

·         Contact insurance companies and other payers regarding unpaid or delayed claims.

·         Research and resolve payment discrepancies and underpayments.

·         Post insurance payments, contractual adjustments, denials, and other account transactions accurately.

·         Identify accounts requiring additional documentation or action from clinical or administrative staff.

·         Maintain appropriate documentation of collection and follow-up activities.

·         Escalate unresolved billing issues to the appropriate supervisor or manager.

Denials and Claim Resolution

·         Research and resolve denied, rejected, and suspended claims.

·         Determine the reason for claim denial and take appropriate corrective action.

·         Prepare and submit corrected claims and appeals when appropriate.

·         Obtain supporting documentation needed for claim appeals.

·         Track denials and identify recurring billing or documentation issues.

·         Communicate recurring denial trends to management and appropriate departments.

·         Work collaboratively with clinical and administrative personnel to prevent future denials.

Home Health and Hospice Responsibilities

·         Maintain knowledge of billing requirements specific to Home Health and Hospice services.

·         Review accounts for required documentation and billing components before claim submission.

·         Monitor authorization and certification information as applicable.

·         Ensure billing reflects services that are supported by appropriate documentation.

·         Coordinate with clinical staff regarding missing documentation that may affect billing.

·         Understand payer requirements related to Home Health and Hospice episodes, services, visits, and levels of care.

·         Assist with resolving billing issues involving changes in payer coverage, eligibility, certification, authorization, and patient status.

·         Maintain awareness of applicable Medicare, Medicaid, commercial payer, and managed care requirements.

Insurance Verification and Eligibility

·         Verify insurance coverage and eligibility when necessary.

·         Identify primary, secondary, and other applicable payers.

·         Review accounts for changes in insurance coverage.

·         Communicate insurance discrepancies to the appropriate department.

·         Assist with resolving coverage and eligibility issues that prevent payment.

Documentation and Compliance

·         Maintain accurate and complete billing records.

·         Follow all applicable federal and state regulations and payer requirements.

·         Maintain confidentiality of patient, employee, financial, and organizational information.

·         Follow HIPAA privacy and security requirements at all times.

·         Ensure billing practices are consistent with organizational policies and procedures.

·         Identify and report potential billing compliance concerns to management.

·         Maintain appropriate documentation to support claims, payments, adjustments, and appeals.

·         Participate in internal audits and billing reviews as requested.

Communication and Teamwork

·         Work cooperatively with Home Health, Hospice, clinical, intake, authorization, coding, medical records, and accounting staff.

·         Communicate professionally with patients, families, insurance representatives, Medicare/Medicaid representatives, providers, and other outside entities.

·         Respond promptly to billing questions and requests for additional information.

·         Assist management with identifying workflow issues that may negatively affect reimbursement.

·         Provide feedback regarding recurring billing, documentation, or payer issues.

·         Maintain professional working relationships with all departments.

ADDITIONAL RESPONSIBILITIES

·         Maintain current knowledge of payer policies, billing regulations, and industry changes affecting Home Health and Hospice reimbursement.

·         Participate in staff meetings, training, and educational opportunities.

·         Assist with special billing projects and audits as assigned.

·         Cross-train with other billing and revenue cycle functions as needed.

·         Maintain productivity and accuracy standards established by the department.

·         Perform other duties as assigned by management.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES

·         Knowledge of medical billing and reimbursement practices.

·         Knowledge of Medicare, Medicaid, commercial insurance, and managed care billing.

·         Understanding of Home Health and Hospice billing processes preferred.

·         Strong attention to detail and accuracy.

·         Ability to analyze and resolve billing discrepancies.

·         Ability to understand insurance explanation of benefits, remittance advice, denials, and payment information.

·         Strong organizational and time-management skills.

·         Ability to prioritize multiple accounts and deadlines.

·         Excellent written and verbal communication skills.

·         Ability to maintain confidentiality and handle sensitive information appropriately.

·         Ability to work independently while functioning effectively as part of a team.

·         Proficiency with computers and electronic billing systems.

·         Ability to learn and utilize electronic medical records, billing software, payer portals, and clearinghouse systems.

EDUCATION AND EXPERIENCE

Required:

·         High school diploma or equivalent.

·         Previous experience in medical billing, healthcare revenue cycle, accounts receivable, or a related field.

Preferred:

·         Previous Home Health or Hospice billing experience.

·         Experience with Medicare and Medicaid billing.

·         Experience with electronic claims submission and clearinghouse systems.

·         Experience working with insurance denials and appeals.

·         Experience with healthcare electronic medical records and billing software.

·         Medical Billing or related certification is preferred but not required.

PHYSICAL REQUIREMENTS

·         Ability to sit for extended periods while performing computer and administrative duties.

·         Ability to use a computer, keyboard, telephone, and other office equipment.

·         Ability to communicate effectively in person, by telephone, and electronically.

·         Ability to occasionally lift, carry, or move office materials and supplies.

·         Regular attendance and punctuality are required.