Home Health PDN Biller

Job Description

Job Description

About the Role

We're looking for an experienced, detail-oriented Home Health PDN Biller to join our billing team in Houston, TX. In this role, you'll own the billing and reimbursement process for Private Duty Nursing services — from claim submission and payment posting through denial management — while ensuring full compliance with Medicaid, Medicare, Managed Care Organizations (MCOs), and commercial payer requirements.

This is a great fit for someone who knows home health billing inside and out, is comfortable navigating EVV (Electronic Visit Verification) systems and authorization workflows, and enjoys collaborating across Clinical, Scheduling, Intake, and Accounts Receivable teams to keep the revenue cycle running smoothly.

What You'll Do

PDN Billing Operations

• Prepare, review, and submit accurate claims for Private Duty Nursing services

• Verify patient eligibility, insurance coverage, and payer information before billing

• Confirm services billed are supported by physician orders, nursing documentation, and approved authorizations

• Validate EVV records prior to claim submission

• Submit electronic claims within payer deadlines and billing cycles

Revenue Cycle Management

• Monitor claim status from submission through payment

• Investigate and resolve claim rejections, denials, and payment discrepancies

• Follow up on unpaid claims and initiate appeals when needed

• Reconcile payments and ensure accurate payment posting

• Identify billing trends and recommend corrective actions

Authorization & Compliance

• Verify valid prior authorizations before billing and monitor utilization/expiration

• Coordinate authorization renewals with Intake and Clinical teams

• Maintain compliance with Medicaid, Medicare, MCO, HIPAA, and other regulatory requirements

Documentation & Reporting

• Review nursing visit documentation for completeness and billing accuracy

• Prepare daily, weekly, and monthly billing reports

• Track KPIs including clean claim rate, denial rate, days in A/R, and collection rate

Required

• High school diploma or equivalent (Associate's or Bachelor's degree preferred)

• 2–3+ years of Home Health or PDN billing experience

• Strong knowledge of Medicaid, Medicare, MCO, and commercial payer billing requirements

• Experience with Electronic Visit Verification (EVV) systems

• Proficiency in home health billing software and EMR systems

• Solid understanding of revenue cycle management

• Strong analytical, organizational, and communication skills

• Proficiency in Microsoft Office Suite, especially Excel

Preferred

• Certified Professional Biller (CPB) certification

• Experience with Texas Medicaid PDN billing

• Experience with denial management and appeals

• Familiarity with payer portals and electronic claims clearinghouses

• Competitive executive salary

• Medical insurance

• Paid time off / holidays