Pre-Bill Specialist

Pre-Bill Specialist Join Synergy’s high-performing revenue cycle team as a Pre-Bill Specialist! We are seeking a detail-driven, compliance-focused professional to ensure accuracy and completeness of all documentation before claims are submitted. Your commitment to precision will directly support clean claims, faster reimbursement, and the overall financial health of our patient-centered services. About the Role The Pre-Bill Specialist is responsible for conducting comprehensive audits of patient charts prior to claim submission. This role ensures that all required documentation, authorizations, visit notes, orders, and payer-specific elements are complete, compliant, and correctly aligned with billing requirements. As a critical part of the revenue cycle, this position helps prevent denials, accelerate reimbursement, and safeguards regulatory compliance across Home Health and Hospice programs. Key Responsibilities Chart Review & Audit – Perform detailed prebilling audits on all Home Health and Hospice charts to verify documentation completeness and accuracy. Confirm all visit notes, supervisory notes, plans of care, OASIS assessments, certifications, and recertifications are signed, dated, and compliant with payer and regulatory requirements. Complete an administrative record audit following patient discharge or prior to billing and forward abnormal results to the Clinical Director or their designee for clinical audit. Supervise the use of the clinical records information system and maintain a comprehensive working knowledge of the system including upgrades and enhancements. Authorization & Eligibility Verification – Validate patient eligibility, insurance coverage, and authorization requirements prior to claim release. Ensure authorizations are active and applicable to the dates, disciplines, and service types billed. Compliance & Quality Assurance – Identify missing or noncompliant documentation and collaborate with clinical teams to resolve deficiencies prior to billing. Ensure all documentation adheres to federal and state regulations, Medicare/Medicaid requirements, and internal policies. Maintain clinical record systems in compliance with state and federal regulations. Coordination & Communication – Work closely with clinical, scheduling, and billing teams to resolve documentation gaps that may delay claim submission. Provide timely feedback and clarification on documentation discrepancies to ensure efficient workflow. Communicate effectively, professionally, and thoroughly with staff regarding coordination of care expectations, educate and enforce deadlines, and establish and maintain positive working relationships with current staff and contract staff. Regulatory & Billing Alignment – Maintain current knowledge of Home Health and Hospice regulatory requirements, and payer-specific prebilling criteria. Verify that documentation supports the codes, service lines, frequencies, and episodes billed. Qualifications Minimum of 1 year of experience in Home Health or Hospice documentation review, QA, billing, or coding. Understanding of Medicare, Medicaid, Government, and Commercial payer documentation requirements. Experience working within an EMR and familiarity with workflow queues, chart audits, and documentation compliance. Knowledge of corporate business management and governmental regulations. Demonstrates good communication skills and public relations skills. Preferred Prior experience conducting prebilling or QA reviews in a Home Health or Hospice setting. Familiarity with CMS requirements for Home Health and Hospice admissions, signed orders compliance, regulatory forms and criteria for compliant billing. Experience with Home Care Home Base (HCHB) EMR, Mosai (formerly known as Forcura) e-fax portal. Skills & Competencies Exceptional attention to detail and strong commitment to documentation accuracy. Ability to identify compliance issues and communicate them clearly and professionally. Highly organized with the ability to manage multiple charts and deadlines simultaneously. Strong critical thinking skills to evaluate chart completeness and identify potential issues before claims are submitted. Collaborative and proactive approach to working with clinical and billing teams. Ethical and compliance-driven mindset. If you take pride in accuracy, compliance, and ensuring a smooth revenue cycle, we invite you to apply for the role of Pre-Bill Specialist today! We are an equal opportunity employer committed to ensuring that all conditions and privileges of employment, including recruitment, hiring, evaluation, transfer, promotion, discipline, determination of compensation and/or benefits, and termination of employment, for all job classifications, are based on qualifications and work record. No employment decision is made, nor do we discriminate, on the basis of race, color, religion, creed, sex/pregnancy, sexual orientation, gender identity, gender expression, age, national origin, ancestry, citizenship, veteran status, or disability. #J-18808-Ljbffr Deercreekseniorliving