Job Description:
• Process and submit hospice-related claims according to Medicare, Medicaid, and payer billing guidelines.
• Submit claims with appropriate modifiers, including the GW modifier for unrelated services.
• Review claims for accuracy and completeness before billing.
• Verify payer information and billing requirements for correct claim routing and reimbursement.
• Research, analyze, and resolve B9 denial claims.
• Submit claims to appropriate hospice payers for reimbursement.
• Document denial resolution activities and payer communications in the billing system.
• Review correspondence, medical documentation, and supporting records to determine related versus unrelated hospice services.
• Coordinate with hospice providers and clinical staff to obtain supporting documentation.
• Assign financial responsibility based on determination outcomes.
• Ensure accurate and timely charges on client invoices for hospice facilities.
• Bill skilled nursing facilities when charges are their financial responsibility.
• Maintain timely bill-back activities and supporting invoice notes.
• Maintain accurate account notes, audit trails, and supporting documentation for billing and reimbursement activities.
• Support internal and external audits with requested documentation and claim history records.
• Adhere to CMS, HIPAA, Medicare, and organizational compliance requirements.
• Collaborate with billing leadership, hospices, facilities, payers, Sales Teams, and internal departments.
• Maintain management-established productivity, quality, and compliance standards.
• Support coworkers, share best practices, and contribute to department goals.
• Perform other related duties and projects as assigned.
Requirements:
• High School Diploma or GED required.
• Minimum of 2-3 years of healthcare billing experience required.
• Experience with Medicare claims processing, hospice payer billing, denial management, and reimbursement recovery preferred.
• Experience working with skilled nursing facilities and hospice providers preferred.
• Hospice billing experience is a plus but not required.
• Strong knowledge of Medicare hospice billing regulations and reimbursement guidelines.
• Understanding of GW modifier requirements and hospice-related billing practices.
• Knowledge of B9 denial processing and claims resolution procedures.
• Ability to interpret medical documentation and determine related versus unrelated hospice services.
• Strong understanding of healthcare billing and revenue cycle principles.
• Knowledge of HIPAA, CMS regulations, and compliance requirements.
• Excellent analytical, organizational, and problem-solving skills.
• Excellent customer service and interpersonal skills.
• Ability to communicate professionally with external and internal customers, hospice providers, skilled nursing facilities, clients, and Sales Teams.
• Strong written and verbal communication skills.
• Ability to collaborate across departments, support team initiatives, share knowledge, and contribute to a positive work environment.
• Ability to build and maintain productive working relationships.
• Proficiency in billing systems, Microsoft Excel, Outlook, and other business applications.
• Ability to prioritize workload and meet deadlines in a fast-paced environment.
Benefits:
• Remote work arrangement