Billing Specialist

We are seeking an experienced and detail-oriented Home Health & Hospice Medical Biller to join our 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.

Key Responsibilities

• 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

• 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

• 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

Preferred 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

• Excellent written and verbal communication skills

Preferred Qualifications

• Certified Professional Biller CPB, Certified Medical Reimbursement Specialist CMRS, or equivalent credential

• Experience billing Medicaid waiver programs or managed care/Medicare Advantage plans