HOME HEALTH MEDICAL BILLER

Job Description

Job Description Benefits/Perks

• Competitive Compensation
• Great Work Environment
• Career Advancement Opportunities

Job SummaryThe Home Health Medical Biller is responsible for accurately managing the billing cycle for home health services, ensuring timely submission of claims, and securing optimal reimbursement from Medicare, Medicaid, and commercial insurance plans. This role includes verifying patient eligibility, reviewing clinical documentation, coding diagnoses and services, resolving claim denials, following up on outstanding balances, and maintaining strict compliance with federal, state, and payer-specific regulations. The biller collaborates closely with clinicians, intake, quality assurance, and authorization teams to ensure clean claims and accurate billing. Strong attention to detail, proficiency with EMR and clearinghouse systems, and the ability to communicate effectively with payers and internal staff are essential for success in this role.
Responsibilities

• Verify patient insurance eligibility, benefits, and authorization requirements prior to billing
• Review OASIS, plan of care, visit notes, and all clinical documentation to ensure accuracy before claim submission
• Assign appropriate ICD-10 diagnosis codes and HCPCS/CPT codes based on clinical documentation and payer guidelines
• Prepare, submit, and track claims through EMR and clearinghouse systems such as Waystar, or Inovalon
• Monitor claim status and promptly address rejections, denials, and required corrections
• Communicate with insurance companies to resolve billing discrepancies and ensure timely reimbursement
• Follow up on unpaid or underpaid claims and maintain accurate aging reports
• Ensure compliance with Medicare, Medicaid, MassHealth, and commercial payer billing regulations
• Collaborate with intake, QA, authorization, and clinical teams to maintain clean and complete claims
• Update billing records, maintain organized documentation, and prepare financial or billing reports as needed
• Protect patient confidentiality and follow HIPAA requirements
• Provide billing support during audits, recertifications, or payer reviews
• Assist with improvement of billing workflows and recommend process enhancements to reduce claim errors and increase reimbursement

Qualifications

• Associate’s degree in Healthcare Administration, Billing, or related field preferred
• Minimum 1–2 years of medical billing experience, preferably in home health or a similar healthcare setting
• Strong knowledge of Medicare, Medicaid/MassHealth, and commercial insurance billing requirements
• Familiarity with ICD-10 coding, HCPCS, CPT codes, and documentation guidelines
• Experience using EMR systems and clearinghouses (e.g., Axxess, Finale, Waystar, Availity, Inovalon)
• Ability to analyze claim denials, correct errors, and follow through with payer resolution
• Strong understanding of authorization processes and insurance eligibility verification
• Excellent attention to detail and accuracy in data entry
  
  

***** YOU NEED TO LIVE IN MASSACHUSETTS OR NEW HAMPSHIRE***** IN OFFICE JOB *****