Billing Specialist (Home Health)

We are seeking a highly organized and detail-oriented Billing, Insurance, and Authorization Specialist to join our home health agency’s revenue cycle team. This role is critical in ensuring accurate claims submission, timely insurance verification, and proper prior authorization management to maximize reimbursement and minimize denials.

The ideal candidate will have experience in home health billing, strong knowledge of Medicare/Medicaid guidelines, and expertise in managing payer requirements.

Key Responsibilities:
Billing & Claims Management:
• Submit clean and timely claims to Medicaid other commercial insurance payers.
•Review patient accounts for accuracy in coding (ICD-10, CPT, HCPCS), modifiers, and documentation compliance.
Monitor unpaid/denied claims, resolve discrepancies, and reprocess or appeal as needed.
•Post payments, adjustments, and write-offs in accordance with agency policies.
•Generate and analyze billing reports to track revenue cycle performance.

Insurance Verification & Authorization:
•Verify patient insurance eligibility and benefits prior to service initiation and re-verification as required for continued care.
•Obtain and track prior authorizations (PA) and continued authorizations for home health services.
•Communicate with physicians, case managers, and payers to secure necessary approvals.
•Maintain up-to-date knowledge of payer-specific requirements (e.g., Medicare COPs, Medicaid waivers).

Compliance & Quality Assurance:
•Ensure compliance with federal/state regulations (HIPAA, PDGM, OASIS).
•Audit patient files to confirm authorization and billing accuracy.
•Collaborate with clinical teams to address documentation gaps affecting reimbursement.

Qualifications & Skills:
•Experience: 2+ years in home health billing, insurance verification, and authorization.
•Proficiency in Medicare/Medicaid billing rules.
•Strong analytical and problem-solving skills.
•Excellent communication with payers, staff, and patients.

If interested, please DM your resume & your rate.
Notes: EST & No Timetracker.