Billing Specialist

About Us:

Pathways Healthcare is a leading, physician- and nurse practitioner-led home health and hospice organization, committed to redefining recovery through comprehensive, patient-centered care. Our innovative Medical Rehabilitation Program offers a meaningful alternative to institutional rehab, helping people heal at home, with dignity and purpose.

As one of the first home health agencies to adopt AI-assisted documentation, we're investing in tools that give our clinicians time back - saving 5 to 10 hours per week! We have made a deliberate decision not to raise our productivity expectations, so the patients and clinicians win in the end. Technology handles the paperwork and your clinical judgment stays at the center of every note!

We are proud to have ranked in Boston Globe's Top Places to Work in Massachusetts and USA Today's Best Places to Work in the United States since 2023!

Job Description:

• Role: Billing Specialist - Home Health, Hospice & Part B
• Rate: $23-$26/hour
• Main Office location: Westwood, MA
• Schedule: Monday-Friday (8:30-5:00pm)
• Job Type: Full-Time

Qualifications:

Required

• High school diploma or equivalent.
• Previous healthcare billing, accounts receivable, claims, audit, or revenue cycle experience.
• Experience in Home Health, Hospice, Medicare Part B, or another Medicare-focused healthcare billing environment .
• Strong understanding of healthcare reimbursement, insurance requirements, denials, and accounts receivable processes.
• Ability to review patient accounts and identify billing discrepancies or missing information.
• Ability to interpret EOBs, remittance advice, denial codes, claim status responses, and payer correspondence.
• Strong analytical and problem-solving skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple accounts and priorities while meeting deadlines.
• Ability to work independently and collaborate effectively across departments.
• Proficiency with Microsoft Office and healthcare billing or electronic medical record systems.

Preferred

• Home Health or Hospice revenue cycle experience.
• Medicare Part B billing or auditing experience.
• Knowledge of Medicare Home Health and Hospice billing requirements.
• Experience reviewing denials, underpayments, and aging accounts.
• Experience with Medicare Advantage, Medicaid, and commercial insurance plans.
• Experience with Homecare Homebase (HCHB), Inovalon, clearinghouses, or similar revenue cycle systems.
• Experience conducting billing audits or quality reviews.

Responsibilitie s:

• Audit patient accounts for billing accuracy, completeness, and compliance with payer requirements.
• Review accounts prior to billing to identify missing documentation, authorization issues, eligibility concerns, coding discrepancies, or other billing barriers.
• Review billed accounts for potential errors, payment discrepancies, denials, underpayments, or follow-up needs.
• Audit billing notes, account activity, and supporting documentation to ensure appropriate follow-up has occurred.
• Review remittance advice, EOBs, claim status information, payer responses, and denial reasons.
• Research billing discrepancies and determine the appropriate next steps for resolution.
• Identify trends in billing errors, denials, documentation gaps, or payer issues and escalate recurring concerns.
• Work collaboratively with billing, prebill, intake, authorization, clinical, scheduling, and other departments to resolve account issues.
• Monitor assigned work queues, reports, or account lists to ensure outstanding issues are addressed timely.
• Review insurance changes and payer information for potential billing impact.
• Assist with aging reviews, account reconciliation, and identification of accounts requiring correction, appeal, adjustment, or additional follow-up.
• Ensure billing-related documentation and account notes are clear, complete, and accurate.
• Support internal audits and revenue cycle quality-improvement initiatives.
• Provide feedback and education to internal teams when recurring billing or documentation issues are identified.
• Maintain knowledge of Medicare, Medicaid, Medicare Advantage, commercial payer, Home Health, Hospice, and Part B billing requirements applicable to assigned responsibilities.
• Meet established productivity, accuracy, and account-resolution expectations.
• Perform additional revenue cycle and billing audit duties as assigned.

What We Offer:

• 3 weeks PTO annually accrued and 1 week paid sick time!
• Paid Federal Holidays (8 observed annually)
• 401(k) Retirement Plan with employer match
• Blue Cross Blue Shield Medical (Choice of HMO/PPO), Dental, Principal Vision and Life insurance

• 100% company-paid short-term disability coverage

• Flexible Spending Accounts (FSA): Pre-tax accounts available for healthcare and dependent care expenses

• Professional Development & Training Opportunities

• Employee Assistance & Benefits Support through Bennie

• Voluntary Benefits including supplemental life, accident, and disability insurance

Pathways Healthcare is committed to providing exceptional care to our patients and fostering a positive work environment for our team members. If you're passionate about making a difference in people's lives and possess the required qualifications, we encourage you to apply for this exciting opportunity!