Hospice & Palliative Care Medical Billing Specialist

The Hospice & Palliative Care Medical Billing Specialist is responsible for the accurate and timely management of billing, reimbursement, and collections for all hospice and palliative care patients. As a newly established role, this individual will help shape workflows and processes through active feedback and collaboration. This role also ensures compliance with Accreditation Commission for Health Care (ACHC) standards, CMS hospice regulations, and all applicable federal and state requirements. Reviews and verifies patient eligibility for hospice and palliative care services, including certification of terminal illness and benefit period requirements. Confirms and documents patient insurance coverage, including Medicare Hospice Benefit, Medicaid, and commercial payers. Processes, verifies, and submits hospice claims (Medicare Part A, Medicaid, and commercial) in accordance with hospice billing requirements, including election dates, revocations, transfers, levels of care, and occurrence codes. Submits and tracks prior authorizations (PAs) for hospice patients, ensuring timely approval and proper documentation to support uninterrupted care and reimbursement. Ensures accurate billing for all hospice levels of care, including Routine Home Care (RHC), Continuous Home Care (CHC), Inpatient Respite Care (IRC), and General Inpatient Care (GIP). Monitors and submits Notice of Election (NOE) and Notice of Termination/Revocation (NOTR) forms in a timely and compliant manner. Follows up on unpaid, denied, or rejected claims by communicating with payers and patients, resolving billing discrepancies, investigating root causes, and initiating appeals as needed to ensure prompt reimbursement. Posts payments, adjustments, and remittance advice accurately; reconciles accounts in accordance with agency financial policies and Medicare/Medicaid regulations. Reviews accounts receivable for assigned payers and implements strategies to reduce aging balances and improve cash flow. Collaborates with clinical, intake, and administrative staff to ensure documentation supports billed services and meets ACHC standards for accuracy, completeness, and timeliness. Audits patient accounts for billing accuracy, including verification of election statements, physician certifications, and supporting documentation. Ensures compliance with CMS hospice Conditions of Participation (CoPs), HIPAA, ACHC accreditation standards, and other applicable regulations. Maintains current knowledge of hospice reimbursement methodologies, regulatory updates, and payer-specific requirements. Assists with financial reporting, general ledger support, and accounts payable/accounts receivable functions as needed. Basic Qualifications High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred. Minimum of 2–3 years of medical billing experience required; hospice or palliative care billing experience strongly preferred. Working knowledge of hospice billing requirements, including the Medicare Hospice Benefit and hospice levels of care. Experience with billing systems such as DDE, Availity, Medicare Administrative Contractor (MAC) portals (e.g., Palmetto), and Medicaid portals preferred. Strong understanding of medical terminology, ICD-10 coding, and hospice-specific documentation requirements. Knowledge of regulatory standards, including CMS guidelines and ACHC accreditation requirements. Excellent written and verbal communication skills, with the ability to interact professionally with patients, families, payers, and staff. Strong attention to detail, organizational skills, and the ability to manage multiple priorities in a fast-paced environment. Demonstrated ability to work independently, take initiative, and meet deadlines. Proficiency in Microsoft Office applications, particularly Excel, and hospice EMR/billing software. #J-18808-Ljbffr Suburban Health at Home