About this role
Role Overview
- Prepare, review, and accurately submit institutional claims (e.g., UB-04s/CMS-1450s) to Medicare, Medicaid, and all commercial insurance carriers via electronic submission.
- Post all insurance and patient payments, adjustments, and denials to the correct patient accounts in the EMR system, ensuring timely and accurate reconciliation.
- Ensure the correct use of ICD-10 diagnosis codes and revenue codes on all claims to comply with payer requirements and minimize claim rejections.
- Work closely with the Collections team (or perform initial follow-up) on accounts where payment has been delayed, short-paid, or denied, providing necessary documentation to facilitate recovery.
- Conduct thorough pre-billing audits to verify patient eligibility, authorization validity, and documentation completeness before claim submission.
- Communicate effectively with the accounting department regarding cash receipts, month-end closing procedures, and reporting on key billing metrics.
- Stay current on all federal and state regulations, including the Patient-Driven Groupings Model (PDGM) for Home Health and the Hospice payment rates, ensuring claims reflect the latest changes.
Requirements
- At least two (2) years of dedicated experience in medical billing and claims submission
- Proven ability to submit and manage claims to Medicare, Medicaid, and commercial insurance
- Proficiency in navigating an Electronic Medical Record (EMR) and billing system and utilizing clearinghouses for electronic claim submission
- Solid working knowledge of ICD-10, CPT, and revenue codes as they relate to home health and hospice services
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development