Billing Specialist

Job description

The Billing Specialist is responsible for accurate and timely processing of all claims, monthly billing and the collection and research of outstanding accounts receivable. This role ensures compliance with payer requirements and agency policies while supporting optimal reimbursement. Experience in Home Care billing and Article 28 is required. Experience with Home Care Home Base, Medent and HHA Exchange is preferred but not required. Performance Responsibilities and Standards: Claims Management & Billing - Review and analyze claims for accuracy and completeness; obtain or correct missing or inaccurate information related to Home Health and Primary Care billing (PDGM, episodic, professional, institutional claims, and Article 28). - Prepare and submit claims/invoices to appropriate payers and clients within established billing schedules. - Ensure compliance with payer requirements, including Medicare, Medicaid, and commercial insurance guidelines. - Utilize electronic billing systems and EDI software (e.g., Waystar) to submit and track claims , - First-Pass Clean Claim Rate: = 95–98% of claims accepted by the payer on first submission without rejections or edits - Run KPI’s monthly ke...