Basic Dimensions

The Billing Specialist is responsible for processing, reviewing, and submitting billing claims for home health services accurately and in a timely manner. This role ensures compliance with federal, state, and agency regulations, including Medicare and Medicaid requirements. The Billing Specialist collaborates with clinical and administrative staff to resolve billing issues, maintain accurate patient financial records, and support efficient revenue cycle operations. 

Essential Functions

· Claims Processing: Prepare, review, and submit   accurate billing claims for home health services to insurance providers,   Medicare, and Medicaid.

· Prior Authorizations: Submit and track prior   authorizations as required for patient services.

· Electronic Visit Verification   (EVV): Perform EVV   audits, verify visits, and correct discrepancies to ensure accurate billing   and compliance.

· Patient Account Management: Maintain accurate patient billing   records, resolve discrepancies, and update account information.

· Payment Posting: Apply payments received from   insurance providers and patients accurately into the system.

· Denial Resolution: Investigate and resolve claim   denials or rejections in a timely manner.

· Reporting: Generate billing and revenue   reports as needed for management and compliance purposes.

· Collaboration: Work with clinical and   administrative staff to ensure accurate documentation and timely submission   of claims.

· Compliance: Ensure billing practices comply   with federal, state, and agency regulations, including Medicare and Medicaid   guidelines.

· Audit Support: Assist with internal and external audits related to billing and   reimbursement.

Other Duties: Perform additional duties as assigned to support billing and revenue cycle processes. 

Knowledge/Experience

· High school diploma or equivalent   required; associate degree or higher in healthcare administration,   accounting, or related field preferred.

· Minimum of 1–3 years of experience   in medical billing, preferably in home health or rehabilitation settings.

· Knowledge of Medicare, Medicaid,   and state-specific billing regulations, including Electronic Visit   Verification (EVV) requirements.

· Proficiency in billing processes,   claims submission, denial resolution, and revenue cycle management.

· Strong attention to detail,   organizational, and analytical skills.

· Excellent interpersonal and   communication skills for collaborating with clinical and administrative   staff.

Familiarity with electronic documentation systems and compliance requirements 

Salary based on experience.