Prior Authorization Department

Job Description

Job Description

Position Title

Hospice Medical Billing Specialist

Position Summary

The Hospice Medical Billing Specialist is responsible for processing, submitting, and managing hospice claims to Medicare, Medicaid, private insurance companies, and other payers. This role ensures accurate billing, timely reimbursement, compliance with hospice regulations, and effective communication with patients, families, insurance providers, and internal staff.

Essential Duties and Responsibilities

• Prepare and submit hospice claims accurately and timely to Medicare, Medicaid, and commercial insurance carriers

• Review patient charts, physician orders, certifications, and documentation for billing compliance

• Verify insurance eligibility and benefits for hospice services

• Monitor unpaid claims, denials, and appeals to ensure proper reimbursement

• Resolve billing discrepancies and claim rejections promptly

• Post payments, adjustments, and reconcile accounts receivable

• Maintain accurate patient billing records and documentation

• Communicate with insurance companies regarding claim status and payment issues

• Work closely with clinical staff, intake coordinators, and administration to ensure accurate billing information

• Ensure compliance with federal, state, and hospice billing regulations including Medicare hospice guidelines

• Generate billing reports and assist with audits as needed

• Maintain confidentiality in accordance with HIPAA regulations

Qualifications

• High school diploma or equivalent required; associate degree preferred

• Minimum of 1–2 years of medical billing experience required

• Hospice or home health billing experience preferred

• Knowledge of Medicare, Medicaid, and commercial insurance billing processes

• Familiarity with hospice EMR and billing systems

• Strong understanding of ICD-10, CPT, and HCPCS coding basics

• Excellent attention to detail and organizational skills

• Strong communication and problem-solving abilities

• Proficient in Microsoft Office and billing software

Preferred Skills

• Experience with hospice authorization and eligibility verification

• Ability to manage multiple accounts and deadlines

• Knowledge of hospice compliance and regulatory requirements

• Strong accounts receivable and collections experience

Work Environment

• Office-based environment

• May require prolonged periods of sitting and computer use

• Standard business hours with occasional overtime depending on billing cycles

Benefits (Optional Section)

• Health, dental, and vision insurance

• Paid time off

• Retirement plan