Billing Specialist

Position Description  
The Billing Coordinator is a member of the Claims Department and is responsible for accurately processing and submitting claims to the appropriate payers for services provided to Blessings4Ever Home Care Agency consumers. The position works closely with Claims, Consumer Authorization and Eligibility, Payroll, Care Management, and management to identify and resolve billing discrepancies, maintain accurate claim documentation and tracking, and support timely reimbursement. The Billing Coordinator is also responsible for generating and submitting claim batches for payment processing.

Primary Responsibilities:
•    Use HHAeXchange to prepare, review, process, and submit claims while maintaining accuracy and efficiency.
•    Review consumer and visit information for completeness and accuracy prior to claim submission, including visit verification.
•    Generate and submit claim batches to the appropriate payers for processing and payment.
•    Document and maintain complete and accurate billing, claims, and tracking records.
•    Monitor claims for missing, incomplete, or late documentation and promptly notify the appropriate management team members of items that may delay claim processing.
•    Research billing discrepancies, rejected claims, and other claim-related concerns and work with the Claims Specialist and/or management toward resolution.
•    Collaborate with the Consumer Authorization and Eligibility Coordinator to resolve discrepancies involving eligibility, authorizations, claims, or consumer discharge status.
•    Collaborate with Payroll and Care Managers to ensure PCA timesheets and supporting documentation are accurate and contain the information necessary for claims processing
•    Assist with billing for consumers processed through the DPW/Promise system.
•    Maintain confidentiality and handle consumer, caregiver, and billing information in accordance with organizational policies and applicable regulatory requirements.
•    Communicate professionally with internal departments and other parties regarding billing documentation and claim-related issues.
•    Perform other claims- and billing-related duties as assigned based on departmental and business needs.
•    Perform additional duties as assigned by the Operations Manager.
 

Education/Experience Requirements

• High school diploma or equivalent required.
• Experience with HHAeXchange EMR preferred.
• Knowledge of Home and Community-Based Services programs preferred.
• Medical billing experience: 3 years preferred.
• Microsoft Excel experience: 3 years preferred.
• Proficiency with Microsoft Windows and Microsoft Office, including Excel, Word, and PowerPoint.
• Spanish language proficiency preferred

Will demonstrate the following Skills:

• Strong interpersonal, verbal, and written communication skills
• Strong attention to detail with the ability to maintain accurate and organized records.
• Demonstrated organizational, analytical, and problem-solving skills.
• Ability to manage multiple priorities, meet deadlines, and work independently.
• Ability to collaborate effectively in a team environment with a positive, customer service-oriented approach.
• Professional telephone and business communication skills.
• Strong writing skills with appropriate grammar, punctuation, and spelling.
• Ability to understand and comply with regulatory guidelines and organizational policies and procedures.
• Ability to identify discrepancies and escalate billing or documentation concerns appropriately

Physical Demands & Environment 

Working in normal office environment, employee may be required to sit, bend, stoop, use keyboard, see, talk, and hear. May occasionally lift objects of 10 to 25 lbs. In compliance with applicable law, reasonable

accommodations may be made to enable individuals with disabilities to perform the essential functions of the position. 

Exclusion from Federal Programs

Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Chief of Staff, if he/she is threatened with exclusion or becomes excluded from any federally funded program.

This job description is not to be misconstrued to represent an all-inclusive list of duties and/or responsibilities. Management reserves the right to make changes to the job description based on business need at any time, with or without prior notification. 

Blessing 4 Ever Home Care Agency is an Equal Opportunity Employer