Billing Representative, Hospice

This is a fully remote position, open to applicants in United States.

📋 Description

• Process and submit claims related to hospice services in accordance with Medicare, Medicaid, and payer billing guidelines.

• Submit claims with the necessary modifiers, including the GW modifier for services that are not related to the patient's terminal hospice diagnosis.

• Assess claim submissions for accuracy and completeness.

• Verify payer information and billing requirements to ensure correct claim routing and reimbursement.

• Research, analyze, and resolve B9 denial claims.

• Submit claims to the appropriate hospice payers for reimbursement as required.

• Document activities related to denial resolutions and communications with payers in the billing system.

• Review correspondence, medical documentation, and supporting records to ascertain whether services are connected to the patient's hospice diagnosis.

• Collaborate with hospice providers and clinical staff to gather necessary supporting documentation.

• Maintain records that support billing and reimbursement decisions.

• Ensure that financial responsibility is assigned correctly based on determination outcomes.

• Ensure hospice facilities receive accurate and timely charges on client invoices.

• Bill charges back to skilled nursing facilities when they are financially responsible.

• Ensure all billable services are invoiced correctly.

• Maintain prompt turnaround of bill-back activities with appropriate invoice notes.

• Enter detailed, accurate, and compliant account notes while keeping complete audit trails.

• Save, organize, and retain supporting documentation in compliance with company policies and regulatory standards.

• Review documentation prior to claim submissions, invoicing, and reimbursement processing.

• Assist with internal and external audits by providing requested documentation and claim history records.

• Comply with CMS, HIPAA, Medicare, and organizational compliance standards.

• Work in collaboration with billing leadership, hospices, facilities, payers, Sales Teams, and internal departments to enhance efficiency and reimbursement outcomes.

• Maintain productivity, quality, and compliance standards.

• Support colleagues, share best practices, and contribute to departmental goals.

• Perform additional related duties and projects as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 2-3 years of experience in healthcare billing is required.

• Experience in processing Medicare claims, billing to appropriate hospice payers, denial management, and reimbursement recovery is preferred.

• Experience collaborating with skilled nursing facilities and hospice providers is preferred.

• Hospice billing experience is a plus but not mandatory.

• Strong understanding of Medicare hospice billing regulations and reimbursement guidelines.

• Familiarity with GW modifier requirements and hospice-related billing practices.

• Knowledge of B9 denial processing and claims resolution processes.

• Experience in billing and submitting claims to the appropriate hospice payer.

• Ability to interpret medical documentation and differentiate between related and unrelated hospice services.

• Solid understanding of healthcare billing and revenue cycle principles.

• Knowledge of HIPAA, CMS regulations, and compliance requirements.

• Excellent analytical, organizational, and problem-solving abilities.

• Outstanding customer service and interpersonal skills.

• Ability to communicate professionally and effectively with external and internal customers, hospice providers, skilled nursing facilities, clients, and Sales Teams.

• Strong written and verbal communication skills.

• Ability to collaborate effectively across departments, support team initiatives, share knowledge, and foster a positive work environment.

• Proven ability to build and maintain productive working relationships with coworkers, leadership, Sales Teams, and business partners.

• Proficiency in billing systems, Microsoft Excel, Outlook, and other business applications.

• Ability to prioritize tasks and meet deadlines in a fast-paced environment.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment that values teamwork and collaboration.

• Flexible work hours and work-life balance initiatives.