Billing Specialist - Home Health - Private Duty

General Summary: The Private Duty Billing Specialist is responsible for timely and compliant Private Duty billing, authorizations, and reimbursement for their designated region. The position will work directly with the revenue cycle director, billing compliance coordinator, agencies, and intermediary to facilitate a fluid process of billing claims in a timely and successful manner. This position will obtain authorizations as needed, prepare, audit, and submit claims electronically for appropriate payment. This position will be responsible for following up on outstanding claims and taking the appropriate action to ensure timely payment is received.  

Patient Population: N/A

Essential Functions:

1. Collect all the necessary information to prepare claims, coordinating with agencies when appropriate.
2. Bill and submit clean claims electronically and follow up with the Payer.
3. Process, collect, and manage account payments.
4. Monitor claims daily, report totals 
5. Research, correct, and re-submit rejected and denied claims.
6. Follow-up on corrections and report adjustments by utilizing revenue cycle management tool..  
7. Monitor and maintain assigned accounts. Review billing reports to maintain accurate AR balances. Document all follow-ups completed on the claim outstanding balance until the final resolution is reached.
8. Keep accurate and orderly records for all billing and accounts receivable activity.
9. Pre-billing audits as assigned.
10. Proactive in identifying potential reimbursement issues while ensuring effective problem resolution.
11. Coordinate with the Agency and Billing Compliance Coordinator on any relevant process issue impacting billing to establish a resolution. 
12. Report any billing issues that develop into trends to the immediate supervisor.
13. Answer questions from patients, agency staff, and insurance companies.
14. Interpret and process Explanation of Benefits when needed.
15. Professionally make outbound calls, while keeping and improving customer relations..
16. Maintain knowledge of current industry standards related to billing, cognizant of new regulations that impact billing. Prepare and implement any required change accordingly.  

This description is a general statement of essential functions that are required to be performed regularly. It does not exclude other duties as assigned.

Supervises: N/A

Experience:

• Required Private Duty billing experience. 
• Required Authorization request experience.
• Preferred, CareVoyant, Waystar, Availity experience.

Skills:

• Ability to communicate effectively both verbally and in writing. 
• Excellent customer service skills
• Private Duty billing and denial management skills, including VA
• Excellent PC skills, Email, Internet Research, Word Processing, Spreadsheets, PDF, and Patient Accounting software systems knowledge (preferably CareVoyant)
• Reviews and maintains reports and records to ensure accuracy.
• Knowledge in accessing the payer portals.
• Claims preparation and audit, including prebill audits for billing compliance.
• Knowledge of billing regulations and claim submission.
• Detail-oriented and effective in problem resolution and escalation.
• Able to organize duties and functions in a highly effective manner to achieve productivity and quality standards.
• Knowledge of regulations and publications for Private Duty, skilled and unskilled care

Education:

• High school diploma or equivalent. 

Licensure/Certification: N/A

Physical Requirements:

• Prolonged sitting, standing, and walking are required.
• Ability to always handle stressful situations calmly and courteously.
• It requires working under some stressful conditions to meet deadlines and company needs.

Environmental/Working Conditions:

• Works primarily in an office environment.