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Billing Representative – Hospice

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.