Home Health Pre-Billing Specialist

The Home Health Pre-Billing Specialist is responsible for ensuring all documentation and billing requirements are completed accurately and on time before final claim submission. This role is critical to staying compliant with payer guidelines and minimizing billing delays and denials.

RESPONSIBILITIES

• Audit all new admission charts to verify correct entry of patient demographics, payer information and insurance authorization details
• Ensure referral paperwork and insurance verification are completed and properly attached to the patient chart
• Monitor NOA (Notice of Admission) reports daily to identify and resolve missing documentation or issues preventing timely submission
• Run EOE (End of Episode) reports and audit charts to verify visit frequency, completed visits, signed physician orders and referral documentation
• Collaborate with the QA Manager, clinical supervisors and billing staff to resolve outstanding documentation and ensure timely, compliant claim submission
• Contact physician offices directly to follow up on unsigned or missing orders needed for billing
• Coordinate with the Prior Authorization department to confirm authorizations; escalate denials to clinical supervisors for follow-up
• Review and respond to billing team messages about rejected or returned claims; investigate, resolve and resubmit as needed
• Help organize incoming audit requests and prepare and submit documentation for internal, payer or regulatory audits
• Perform additional duties as assigned by the Administrator or Director of Clinical Services

WORKING ENVIRONMENT

Works in the Agency office. Reports to the Director of Clinical Services. Moderate lifting, with regular bending, lifting and standing.

BENEFITS

401(k) with matching, dental, health and vision insurance, and paid time off.

• High school diploma or equivalent required; associate degree or healthcare certification preferred
• 2+ years of experience in home health billing, chart auditing or medical records review preferred
• Knowledge of Medicare/Medicaid regulations, PDGM and home health billing requirements preferred
• Familiarity with EMR systems such as WellSky (Kinnser)
• Excellent organization and attention to detail; able to work under pressure to meet deadlines
• Strong interpersonal and communication skills with internal teams and external providers