Billing Representative (Hospice)

HospiceandMedicareBilling

• Processandsubmithospice-relatedclaimsinaccordancewithMedicare,Medicaid,andpayerbillingguidelines.
• Submitclaimswithappropriatemodifiers,includingtheGWmodifierforservicesdeterminedtobeunrelatedtothepatient'sterminalhospicediagnosis.
• Reviewclaimsubmissionsforaccuracyandcompletenesspriortobilling.
• Verifypayerinformationandbillingrequirementstoensurecorrectclaimroutingandreimbursement.

DenialManagementandClaimsResolution

• Research,analyze,andresolveB9denialclaims.
• Submitclaimstotheappropriatehospicepayerforreimbursementwhenrequired.
• Documentalldenialresolutionactivitiesandpayercommunicationswithinthebillingsystem.

Relatedvs.UnrelatedServiceDeterminations

• Reviewhospiceandskillednursingfacilitycorrespondence,medicaldocumentation,andsupportingrecordstodeterminewhetherservicesarerelatedorunrelatedtothepatient'shospicediagnosis.
• Coordinatewithhospiceprovidersandclinicalstafftoobtainsupportingdocumentationfordeterminationdecisions.
• Maintaindocumentationsupportingbillingandreimbursementdecisions.
• Ensureproperfinancialresponsibilityisassignedbasedondeterminationoutcomes.

SkilledNursingFacilityandClientBilling

• Ensurehospicefacilitiesthatorderservicesreceiveaccurateandtimelychargesonclientinvoices.
• Billchargesbacktoskillednursingfacilitieswhenservicesaredeterminedtobethefinancialresponsibilityofthefacility.
• Ensureallbillableservicesareinvoicedappropriately.
• Maintaintimelyturnaroundofbill-backactivitieswithproperinvoicenotestosupportrevenuecyclegoals.

DocumentationandCompliance

• Ensuredetailed,accurate,andcompliantaccountnotesareenteredintothebillingsystemforallbillingactivities,claimstatusupdates,payercommunications,denials,andreimbursementactions.
• Maintaincompleteaudittrailswithinbillingsystemstosupportclaimprocessingandreimbursementvalidation.
• Save,organize,andretainsupportingdocumentation,includingmedicalrecords,hospicecorrespondence,payernotices,denialletters,anddeterminationdocumentationinaccordancewithcompanypoliciesandregulatoryrequirements.
• Ensurerequireddocumentationisproperlyattachedandmaintainedforcomplianceandauditreadiness.
• Reviewdocumentationforcompletenessandaccuracypriortoclaimsubmission,invoicing,andreimbursementprocessing.
• Supportinternalandexternalauditsbyprovidingrequesteddocumentationandclaimhistoryrecords.
• AdheretoallCMS,HIPAA,Medicare,andorganizationalcompliancerequirements.

RevenueCycleSupport

• Collaboratewithbillingleadership,hospices,facilities,payers,SalesTeams,andinternaldepartmentstoimproveoperationalefficiencyandreimbursementoutcomes.
• Maintainproductivity,quality,andcompliancestandardsestablishedbymanagement.

AdditionalResponsibilities

• Fosteracollaborativeteamenvironmentbysupportingcoworkers,sharingbestpractices,andcontributingtodepartmentgoalsandsuccess.
• Performotherrelatedduties,projects,andresponsibilitiesasassignedbymanagement.
• This job descriptionisnotintendedtobeanexhaustivelistofallduties,responsibilities,orqualificationsassociatedwiththeposition.Responsibilitiesmaybeadded,modified,orreassignedbasedonbusinessneedsandorganizationalrequirements.

Qualifications

Education

• HighSchoolDiplomaorGEDrequired.

Experience

• Minimumof2-3yearsofhealthcarebillingexperiencerequired.
• ExperiencewithMedicareclaimsprocessing,billingtoappropriatehospicepayers,denialmanagement,andreimbursementrecoverypreferred.
• Experienceworkingwithskillednursingfacilitiesandhospiceproviderspreferred.
• Hospicebillingexperienceisaplusbutnotrequired.

Knowledge,Skills,andAbilities

• StrongknowledgeofMedicarehospicebillingregulationsandreimbursementguidelines.
• UnderstandingofGWmodifierrequirementsandhospice-relatedbillingpractices.
• KnowledgeofB9denialprocessingandclaimsresolutionprocedures.
• Experiencebillingandsubmittingclaimstotheappropriatehospicepayer.
• Abilitytointerpretmedicaldocumentationanddeterminerelatedversusunrelatedhospiceservices.
• Strongunderstandingofhealthcarebillingandrevenuecycleprinciples.
• KnowledgeofHIPAA,CMSregulations,andcompliancerequirements.
• Excellentanalytical,organizational,andproblem-solvingskills.
• Excellentcustomerserviceandinterpersonalskills.
• Abilitytocommunicateprofessionallyandeffectivelywithexternalcustomers,internalcustomers,hospiceproviders,skillednursingfacilities,clients,andSalesTeams.
• Strongwrittenandverbalcommunicationskills.
• Mustbeateamplayerwiththeabilitytocollaborateeffectivelyacrossdepartments,supportteaminitiatives,shareknowledge,andcontributetoapositiveworkenvironment.
• Demonstratedabilitytobuildandmaintainproductiveworkingrelationshipswithcoworkers,leadership,SalesTeams,andbusinesspartners.
• Proficiencyinbillingsystems,MicrosoftExcel,Outlook,andotherbusinessapplications.
• Abilitytoprioritizeworkloadandmeetdeadlinesinafast-pacedenvironment.