Summary: 

The Home Health Billing Specialist is responsible for ensuring accurate and timely submission of home health care claims, managing accounts receivable, and resolving billing issues. This role involves working closely with clinical staff, insurance companies, and patients to ensure compliance with federal, state, and payer-specific regulations. 

Key Responsibilities: 

• Prepare and submit claims for home health services to Medicare, Medicaid, private insurance, and other payers.
• Verify patient insurance information and ensure proper documentation for claim submission.
• Monitor accounts receivable and follow up on unpaid claims.
• Identify and resolve billing discrepancies or denials in a timely manner.
• Ensure billing practices comply with Medicare and Medicaid regulations, as well as other payer requirements.
• Stay updated on regulatory changes related to home health billing and reimbursement.
• Maintain accurate patient records and documentation.
• Work with insurance companies to resolve payment issues.
• Generate and review financial reports related to billing and accounts receivable.
• Track key performance indicators (KPIs) such as claim submission turnaround and denial rates. 

Qualifications: 

• High school diploma or GED required; associate degree in healthcare administration, accounting, or a related field preferred.
• Experience in Home Health billing and collections
• Knowledge of Medicare, Medicaid, and private insurance billing procedures.
• Familiarity with billing software Inovalon and HCHB EMR systems
• Proficiency in medical coding (ICD-10, CPT, HCPCS) and understanding of OASIS documentation