Medical Billing Specialist - Home Health & Waiver Services

Medical Billing Specialist - Home Health & Waiver Services

Ready to join a rapidly growing team who improves the lives of families in their communities? If you have a passion for helping others, this might be the right organization for you! Guardian Care is currently seeking a Medical Billing Specialist to join our team.

Position: Medical Billing Specialist - Home Health & Waiver Services

Department: Revenue Cycle Management

Reports To: RCM Supervisor

Status: Full-time

Hours: M-F, 8:00 am- 5:00 pm EST

Position Summary:

• Bill home health and waiver services accurately, timely, and in compliance with Medicare, Medicaid, commercial, private insurance, payer, and agency requirements.
• Support maximum appropriate reimbursement by preparing clean claims, posting payments, monitoring AR, resolving denials, and reducing preventable billing delays.
• Verify eligibility, authorizations, EVV records, service units, payer rules, and documentation requirements before billing or resubmission.
• Collaborate with clinical, administrative, referral, authorization, and leadership teams to resolve documentation, claim, payer, and account issues.

Responsibilities/Job Duties:

• Billing documentation: Maintain accurate records of billing actions, denials, appeals, resubmissions, account updates, payment follow-up, and payer communications.
• Account Notes: Document date, dates of service, payer representative, call reference number, authorization number, appeal/dispute number, action taken, and next follow-up step when applicable.
• System accuracy: Ensure updates entered in billing systems, payer portals, EMR/EHR, and related platforms are complete, timely, and consistent with agency procedure.
• Confidentiality: Maintain HIPAA compliance and protect all patient, payer, employee, and agency information.
• Perform other duties as assigned based on the needs of the home care agency, home health service line, waiver service line, billing department, and leadership team.
• Assist with special projects, startup support, workflow development, payer process updates, and cross-department communication as assigned.

Required Qualifications:

• High school diploma or GED preferred.
• Two or more years of applicable healthcare billing, revenue cycle, home health, waiver services, Medicaid, Medicare, or insurance billing experience strongly preferred.
• Experience with DDE and Waystar preferred, including understanding of claim flow between Waystar and DDE.
• Knowledge of PDGM, Lupa's and how they work in the claim and accounts receivables.
• Experience with Medicaid waiver billing, EVV, denial management, AR follow-up, payment posting, payer portals, or authorization workflows preferred.
• Medical terminology proficiency preferred.
• Strong computer proficiency and ability to work accurately across multiple software systems.

Technical Competencies:

• Knowledge of claim submission, payer requirements, remittance review, denial correction, appeals, AR follow-up, write-offs, and billing compliance.
• Ability to review authorizations, eligibility, service units, EVV data, payer rules, and documentation for billing readiness.
• Ability to generate, review, and explain billing, denial, AR, payment, and monthly reporting information.
• Ability to use general office equipment, including multi-line phone, fax, copier, scanner, and computer-based software programs.

Behavioral Competencies:

• Detail-oriented with strong analytical, reconciliation, and problem-solving skills.
• Organized and able to manage multiple accounts, payers, deadlines, tasks, and follow-up priorities.
• Professional communicator with payers, clients, care managers, clinical staff, leadership, and billing team members.
• Adaptable and willing to cross-train across home health, waiver services, payer types, and new agency processes.
• Team-focused, dependable, and able to assist other billing staff as agency needs change.
• Courteous, compassionate, respectful, and positive when working with internal and external customers.

Work Environment:

• Remote or office-based work as assigned by the agency.
• Frequent computer use, phone communication, data entry, payer portal activity, document review, and account follow-up.
• Must manage deadlines, interruptions, payer follow-up, competing priorities, and confidential information while maintaining accuracy and professionalism.
• Equipment and Software Used:
  • Computer and multiple software programs, including EMR/EHR, billing systems, payer portals, DDE, Waystar, iQIES, EVV platforms, and Microsoft Office or similar applications.
  • Multi-line telephone, fax, copier, scanner, and other standard office equipment.

Equal Opportunity Statement:

We are an equal opportunity employer committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other protected status under applicable law.