Billing & Revenue Cycle Coordinator

BROCKTON HOME HEALTH CARE AGENCY

Billing & Revenue Cycle Coordinator

Department: Administration / FinanceReports To: Administrator Employment Status: Full-TimePosition Type: Administrative / Revenue Cycle Management

POSITION SUMMARY

Brockton Home Health Care Agency is establishing the position of Billing & Revenue Cycle Coordinator to strengthen oversight of the agency’s billing, claims, authorizations, and accounts receivable processes.

The Billing & Revenue Cycle Coordinator will serve as the primary liaison between Brockton Home Health Care Agency’s clinical department and the agency’s external billing company.

The primary purpose of this position is to ensure and manage that services provided by the agency are properly authorized, documented, billed accurately, submitted timely, and followed through to payment.

This position is not intended to process billing. The coordinator will provide a level of internal oversight and accountability to help identify billing errors, authorization issues, documentation problems, missed claims, denials, and outstanding receivables before they negatively affect the agency.

KEY RESPONSIBILITIES

1. Weekly Billing Oversight

Review the agency’s weekly billing activity and verify that eligible services have been submitted for billing.

Compare scheduled and completed services against claims being prepared or submitted by the billing company.

Identify services that were provided but have not yet been billed and determine the reason for the delay.

Review billing for accuracy, including patient/member information, payer, authorization, service dates, units, and applicable billing codes.

Maintain a weekly billing reconciliation process so management can clearly identify:

• Services provided
• Claims submitted
• Claims pending
• Claims held
• Claims denied or rejected
• Payments received
• Outstanding accounts receivable

2. Prior Authorization (PA) Oversight

Review active Prior Authorizations to ensure services being provided and billed are within the approved authorization period, service type, frequency, and units.

Track PA effective dates and expiration dates and communicate upcoming expirations to the appropriate clinical or administrative staff.

Identify services that may be at risk of nonpayment because of expired, missing, incorrect, or insufficient authorizations.

Work with the Clinical Manager and appropriate staff to resolve discrepancies before claims are submitted whenever possible.

3. Billing Company Liaison

Serve as the agency’s primary internal contact with the external billing company.

Participate in a weekly billing and accounts receivable meeting with the billing company.

Prepare issues requiring discussion before each meeting and maintain a follow-up list of unresolved items.

Request clarification and supporting information regarding rejected, denied, unpaid, or delayed claims.

Hold the billing company accountable for timely claim submission, correction, resubmission, and follow-up.

Escalate significant or recurring billing concerns to agency management.

4. Clinical Department Coordination

Work closely with the Clinical Manager and clinical team to make sure documentation required for billing is complete and submitted timely.

Identify claims that cannot be billed because of missing, incomplete, unsigned, or late clinical documentation.

Communicate documentation deficiencies to the appropriate department and track them until resolved.

Help ensure that the services documented in the clinical record support the services being billed.

5. Claims Accuracy & Timely Filing

Monitor claims to make sure they are submitted within payer timely-filing requirements.

Review rejected and denied claims to identify the cause and coordinate corrective action.

Track corrected claims, resubmissions, appeals, and other follow-up activities when applicable.

Identify recurring billing errors and recommend process improvements to prevent them from happening again.

Maintain a system for identifying claims approaching filing deadlines so corrective action can be taken before revenue is lost.

6. Accounts Receivable (A/R) Oversight

Monitor the agency’s accounts receivable and outstanding claims.

Review A/R aging reports regularly, including claims outstanding for:

0–30 days | 31–60 days | 61–90 days | 90+ days

Investigate significant or aging balances and determine the reason payment has not been received.

Work with the billing company to ensure appropriate follow-up is being completed.

Immediately escalate high-dollar claims, unusual payment delays, repeated denials, or significant payer issues to management.

7. Payment Reconciliation

Assist in verifying that payments received correspond with submitted claims.

Review payer remittance information when necessary to identify underpayments, denials, recoupments, adjustments, or other discrepancies.

Report significant payment discrepancies to management and the billing company for investigation.

PERFORMANCE EXPECTATIONS

Success in this position will be measured by the coordinator’s ability to:

• Improve billing accuracy
• Reduce preventable claim denials and rejections
• Reduce unbilled services
• Identify authorization problems before billing
• Improve timely claim submission
• Reduce aging accounts receivable
• Improve communication between clinical staff and the billing company
• Identify missing documentation affecting reimbursement
• Provide management with accurate weekly revenue-cycle information
• Follow outstanding claims through resolution

QUALIFICATIONS

Preferred qualifications include:

• Experience with home health, healthcare billing, revenue cycle, claims, or accounts receivable
• Knowledge of Medicare, Medicaid/MassHealth, managed care, and commercial insurance billing processes
• Familiarity with Prior Authorizations and payer requirements
• Understanding of claim denials, remittance information, timely filing, and A/R aging
• Strong attention to detail and organizational skills
• Ability to review reports and identify discrepancies
• Strong communication and follow-up skills
• Ability to work effectively with clinical, administrative, and external billing teams
• Ability to handle confidential patient and financial information appropriately
• Proficiency with spreadsheets, electronic health records, billing platforms, and payer portals

Compensation: This is a full-time, salaried position with an annual salary of $60,000, paid in accordance with Brockton Home Health Care Agency’s regular payroll schedule.