Home Health Medical Billing Specialist

About the Role

The Home Health Medical Billing Specialist supports critical components of the Revenue Cycle Management (RCM) process, focusing on claim entry, billing validation, and prebilling payroll quality assurance. This role bridges the gap between home health aide (HHA) hours and accurate insurance billing, ensuring that compliance and efficiency remain at the highest standards.

Key Responsibilities

1. Claims Preparation & Submission

• Review and prepare medical claims for submission to insurance providers.
• Ensure all required CPT, diagnosis, revenue codes, and place-of-service codes are accurate before claims are submitted.
• Convert Electronic Visit Verification (EVV) records into billable claims within the billing platform.
• Enter and manage 60–75 claims per day while maintaining high accuracy.

2. Billing, Payroll, & Revenue Cycle Support

• Conduct weekly payroll Quality Assurance (QA) of HHA hours to ensure accurate pay.
• Perform weekly QA of HHA visits to be sent for billing to Managed Care Organizations (MCOs), executing quality checks to ensure charted and worked hours match the hours authorized by the health plan.
• Support key components of the Revenue Cycle Management (RCM) process, with a primary focus on claim entry and billing.
• Verify that claims contain complete and accurate billing information prior to submission and assist with Coordination of Benefits (COB) when applicable.
• Monitor claims to ensure compliance with payer requirements.

3. Systems & Documentation

• Enter and manage claims within billing systems such as CollaborateMD (CMD).
• Maintain accurate records within the billing platform and related systems.
• Utilize multiple systems simultaneously and work effectively using dual monitors and screen-sharing tools.

4. Collaboration & Communication

• Communicate with internal teams regarding billing documentation or claim issues.
• Follow established billing workflows and escalate issues when necessary.
• Maintain clear and professional communication in English (written and spoken).

Role Requirements (Non-Negotiables)

• Experience: 2–3 years of experience in U.S. medical billing.
• RCM Knowledge: Strong understanding of the Revenue Cycle Management (RCM) process.
• Coding Proficiency: Experience with CPT codes, diagnosis codes, revenue codes, and place-of-service codes.
• Claim Submission: Experience preparing and submitting insurance claims with the ability to process high claim volumes while maintaining accuracy.
• Industry Background: 1+ year of Home Health billing experience.
• Technical Skills: Proficiency in Excel/Google Sheets and EHR/EMR systems. Comfortable working with multiple systems and technologies using dual monitors and screen-sharing tools.
• Soft Skills: Excellent attention to detail, strong organizational skills, and the ability to follow detailed instructions.
• Language: Strong written and spoken English communication skills.
• Disqualifier: Must be highly adaptable to change and willing to adapt to changes in the role.

Preferred Qualifications (Nice-to-Have)

• Experience with Medicaid billing.
• Experience working in remote or distributed teams.
• Experience with CollaborateMD (CMD).
• Familiarity with tools such as Availity, NaviNet, Waystar, NextGen, or Avaya.

Performance Metrics

Success in this role will be measured by:

• Number of claims processed daily.
• Accuracy of claim submissions and low error rates.
• Clean claim rate.
• Overall productivity and adherence to billing processes.

Other Details:

• Location: Remote (Open to candidates from the Philippines)
• Schedule: 9:00 AM – 5:00 PM EST

Benefits:

• Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – global team members are eligible for an annual company performance bonus.
• Generous paid time off. We provide 15 days of paid time off that allow you to recharge, along with 10 paid company US holidays.
• Growth Opportunities. Build your leadership skills while working with teams in various markets across the US.