Billing Manager FOR Home Health

BROCKTON HOME HEALTH CARE AGENCY

BILLING MANAGER

Department: AdministrationPosition: Billing ManagerEmployment Status: Full-TimeReports To: AdministratorLocation: Brockton, Massachusetts

POSITION SUMMARY

Brockton Home Health Care Agency is seeking an experienced and detail-oriented Billing Manager to manage the agency’s day-to-day billing and claims activities.

The Billing Manager is responsible for preparing, reviewing, and submitting accurate claims to Medicare, MassHealth/Medicaid, managed care organizations, and other contracted payers. This position will also research rejected and denied claims, correct billing errors, submit corrected claims and appeals when appropriate, monitor outstanding accounts receivable, and follow claims through final resolution.

The primary goal of this position is to ensure that all properly authorized and documented services are billed accurately and on time, and that every unpaid, rejected, or denied claim receives appropriate follow-up.

ESSENTIAL RESPONSIBILITIES

1. Claims Preparation & Submission

• Prepare and submit claims accurately and within required payer deadlines.
• Review claims before submission for completeness and accuracy.
• Verify patient/member demographics, insurance information, dates of service, authorization, units, service codes, modifiers, and other required billing information.
• Submit electronic and manual claims as required by individual payers.
• Ensure claims are accepted by the payer or clearinghouse after submission.
• Correct rejected claims promptly and resubmit them.
• Prevent duplicate or inappropriate billing.
• Maintain documentation of claim submission and correction activity.

2. Denial & Rejection Management

The Billing Manager will take ownership of denied and rejected claims from identification through resolution.

Responsibilities include:

• Review rejected and denied claims regularly.
• Research the specific reason for each denial.
• Determine whether the issue relates to authorization, eligibility, coding, documentation, timely filing, payer processing, or another cause.
• Correct billing errors and resubmit claims promptly.
• Prepare reconsiderations or appeals when appropriate.
• Contact insurance companies and payer representatives when additional research is necessary.
• Track denials until payment or final resolution.
• Maintain a denial log showing the claim, dollar amount, payer, denial reason, corrective action, responsible party, and status.
• Identify recurring denial patterns and report them to management.
• Recommend corrective actions to prevent repeated denials.

3. Prior Authorization Review

Before billing, verify that services requiring authorization have a valid PA covering the:

• Correct member
• Service type
• Dates of service
• Authorized units/hours/visits
• Frequency
• Applicable billing code

Immediately report missing, expired, insufficient, or incorrect authorizations to the appropriate department.

Do not knowingly submit claims for services that do not meet applicable authorization requirements without appropriate management review.

4. Eligibility & Insurance Verification

Verify insurance eligibility and payer information as required before claim submission.

Identify changes in coverage, terminated eligibility, secondary insurance, payer changes, or other issues that may affect billing.

Communicate eligibility problems promptly so they can be resolved before they result in unnecessary denials.

5. Clinical Documentation & Billing Coordination

Work closely with the Clinical Manager and clinical staff to ensure required documentation is available to support billing.

Identify services that cannot be billed because of:

• Missing visit notes
• Incomplete documentation
• Missing signatures
• Documentation submitted late
• Authorization discrepancies
• Plan-of-care issues
• Other billing-related documentation deficiencies

Track held claims until the issue has been corrected.

The Billing Manager must never create, alter, backdate, or improperly modify clinical documentation to support a claim.

6. Accounts Receivable Management

Monitor outstanding accounts receivable and follow up on unpaid claims.

Review A/R aging, including:

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

Prioritize high-dollar and aging claims.

Research why claims remain unpaid and take appropriate follow-up action.

Document payer calls, claim status, reference numbers, corrective actions, and expected next steps.

Escalate significant or unresolved payer issues to management.

7. Timely Filing Management

Maintain awareness of payer-specific claim filing and appeal deadlines.

Monitor unbilled and denied claims approaching timely-filing limits.

Take appropriate action before deadlines whenever possible.

Immediately notify management when a claim is at risk of becoming uncollectible because of a filing or appeal deadline.

8. Payment & Remittance Review

Review EOBs, ERAs, remittance advice, and payer correspondence as assigned.

Identify:

• Denials
• Partial payments
• Underpayments
• Overpayments
• Recoupments
• Adjustments
• Incorrect contractual reductions
• Claims paid incorrectly

Research discrepancies and initiate appropriate follow-up.

10. PAYER FOLLOW-UP

Communicate professionally with Medicare, MassHealth/Medicaid, managed care organizations, commercial insurers, clearinghouses, and other payers as necessary.

Maintain documentation of payer communications and reference numbers.

Follow unresolved claims through completion rather than simply documenting that a payer was contacted.

11. MONTHLY DENIAL ANALYSIS

Prepare a monthly denial report identifying:

• Total number and dollar amount of denials
• Denials by payer
• Primary denial reasons
• Authorization-related denials
• Eligibility-related denials
• Documentation-related denials
• Timely-filing denials
• Corrected/resubmitted claims
• Appeals submitted
• Claims recovered
• Claims still outstanding

Management should be notified when recurring problems indicate a process, clinical, payer, or billing-system issue.

12. COMPLIANCE & BILLING INTEGRITY

Maintain billing practices consistent with applicable payer requirements, agency policies, and federal and Massachusetts healthcare program requirements.

The Billing Manager must never knowingly:

• Submit a claim for a service not provided.
• Submit unsupported claims.
• Falsify or alter documentation.
• Intentionally bill incorrect units or services.
• Duplicate bill.
• Change service information solely to obtain payment.
• Conceal known billing errors.

Suspected overpayments, duplicate payments, inappropriate billing, or other significant billing discrepancies must be reported promptly to the Administrator.

CONFIDENTIALITY

Maintain the confidentiality and security of patient/member information, financial information, payer information, passwords, and agency records.

Follow HIPAA requirements and Brockton Home Health Care Agency's privacy and security policies.

REQUIRED QUALIFICATIONS

• Previous healthcare billing experience required.
• Home health billing experience strongly preferred.
• Experience submitting and correcting electronic healthcare claims.
• Experience researching claim denials and rejections.
• Knowledge of accounts receivable and revenue-cycle processes.
• Knowledge of Medicare and Medicaid/MassHealth billing preferred.
• Experience with managed care billing preferred.
• Understanding of prior authorizations and insurance eligibility.
• Familiarity with EOBs, ERAs, claim status, and denial codes.
• Understanding of timely-filing requirements.
• Ability to navigate payer portals and clearinghouses.
• Strong computer and spreadsheet skills.
• Strong mathematical and reconciliation skills.
• Excellent attention to detail.
• Strong problem-solving and research skills.
• Ability to manage multiple claims and deadlines simultaneously.
• Strong written and verbal communication skills.
• Ability to work independently and maintain organized records.
• Ability to protect confidential patient and financial information.

PREFERRED EXPERIENCE

Preference may be given to candidates with experience in:

• Massachusetts home health billing
• Medicare home health billing
• MassHealth billing
• Managed care organizations
• Medicare Advantage plans
• Medicaid managed care
• Prior authorization management
• Claim appeals
• Revenue-cycle management
• A/R recovery
• Electronic clearinghouses and payer portals

PERFORMANCE EXPECTATIONS

Performance will be evaluated based on measurable factors including:

• Claim submission accuracy
• Timeliness of billing
• Rejection rate
• Preventable denial rate
• Speed of rejected-claim correction
• Denial resolution
• A/R aging
• Timely-filing compliance
• Reduction of unbilled services
• Recovery of denied/unpaid claims
• Accuracy of weekly billing reports
• Follow-through on outstanding claims

KEY PRINCIPLE OF THE POSITION

The Billing Manager's responsibility does not end when a claim is submitted.

The position is responsible for helping manage the full billing cycle:

Service Provided Documentation Completed Authorization Verified Eligibility Verified Claim Prepared Claim Submitted Claim Accepted Payment Received Payment Reconciled

When that cycle stops at any point, the Billing Manager is expected to identify the problem, research the cause, take appropriate corrective action, and follow the claim until resolution or management escalation.

PRIMARY OBJECTIVE

Bill every properly documented and authorized service accurately and on time, minimize preventable denials, aggressively follow outstanding claims, and protect Brockton Home Health Care Agency's revenue while maintaining billing integrity and compliance.

Compensation: This is a full-time, salaried position with an annual salary of $82,000, paid in accordance with Brockton Home Health Care Agency’s regular payroll schedule.