Home Health Biller-Pro Care Home Health

Essential Duties and Responsibilities:  The Medical Billing Specialist is responsible for managing accurate, timely completion and submission of all billing, collections, and accounts receivable functions associated with home health claims.

•  Ensures reimbursement through efficient billing and collections operations and 
• Initiates billing process by submitting NOA.
• Obtain patient eligibility and authorizations.
•  Verify payor information, insurance, and eligibility prior to admission. Verify Medicare, HMO, and private insurances.
• Track authorizations from admit to discharge.
• Processing, monitoring, and collecting of Medicare, Medicaid, and other commercial insurance claims in accordance with payer requirements.
•  Provides oversight and approval of claims audits and processing. Conducts final billing audit and issues assignments to pre-billing team when findings require further documentation.
•  Maintains comprehensive working knowledge of payer contracts and ensures that payers are billed according to contract provisions. Represents and acts on behalf of agency in resolving conflicts with payers.
•  Advises Director in matters of accepting/declining problematic payers.
•  Maintains comprehensive working knowledge of government billing regulations including Medicare and Medicaid regulations and serves as a resource for appropriate agency personnel.
• Following up on accounts for billing and on overdue accounts for collections via phone calls, re-submissions, and adjustments for billing errors.
•  Verifying accuracy of billing data and revising any errors.
•  Importing/posting payments from all payer types.
•  Timely resolution of all claims including appeals..
• Supervises the use of the billing information system and maintains a comprehensive working knowledge of the system including upgrades and enhancements.
•  Establishes and maintains positive working relationships with patients, family members, payers, and referral sources.
•  Protects the confidentiality of patient and agency information 

Education and/or Work Experience Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•  Demonstrated knowledge of billing regulations for Medicare, Medicaid and insurance processing, medical terminology and coding.
• Knowledge of regulatory and accreditation standards for home care specific to the reimbursement area.
•  Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
•  Minimum one (1) year of experience in health care billing and collections, preferably in home care.
•  Information system knowledge in the areas of electronic claim submission and data entry/report generation.
•  Demonstrated organizational skills, detail orientation, flexibility and ability to work with minimal supervision.