Billing Coordinator

POSITION SUMMARY: The Billing Coordinator is responsible for performing all billing functions for the agency, ensuring claims are submitted accurately and on time to all payers. This role is crucial for revenue cycle success and requires deep knowledge of complex home health and hospice billing rules.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• 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.
• Other appropriate services and special projects as assigned.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

QUALIFICATIONS & REQUIREMENTS FOR THE POSITION:

• At least two (2) years of dedicated experience in medical billing and claims submission, with a strong preference for experience in home health or hospice billing.
• 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