Responsibilities
- Implements and adheres to VitalCaring’s established Hospice billing Standard Operating Procedures, ensuring compliance with Medicare Hospice Conditions of Participation and regulatory guidelines.
- Prepares, reviews, and submits hospice claims accurately and timely, including Medicare, Medicaid, Managed Care, and other third-party payors.
- Ensures proper billing of hospice levels of care, including: Routine Home Care (RHC) Continuous Home Care (CHC) General Inpatient Care (GIP) Inpatient Respite Care (IRC)
- Verifies timely Notice of Election (NOE) submission and ensures hospice election statements, physician certifications, and recertifications are complete and compliant prior to billing.
- Reviews documentation to confirm appropriate revenue codes, occurrence codes, discharge status codes, and length of stay compliance.
- Identifies, investigates, and resolves billing edits, claim rejections, denials, and payment discrepancies, including coordination of benefit (COB) scenarios.
- Collaborates with Branch Directors, Clinical Managers, and Admissions teams to obtain missing documentation and resolve discrepancies impacting reimbursement.
- Accurately documents billing coordination notes in the EMR to ensure effective communication between branch and revenue cycle teams.
- Uploads remittance advices, payor correspondence, and supporting documentation into the EMR according to company guidelines.
- Monitors and reconciles payments, ensuring accurate posting and identification of underpayments or overpayments.
- Meets or exceeds established productivity and quality benchmarks while maintaining accuracy and compliance.
- Maintains strict confidentiality of all patient and financial data in accordance with HIPAA and company policies.
- Supports audit preparedness, including ADRs, TPE reviews, and other Medicare or third-party payor audits.
- Participates in ongoing education regarding hospice reimbursement updates, regulatory changes, and industry best practices.
- Performs other duties as assigned to support operational and revenue cycle excellence.
Requirements
- Minimum of one (1) year of healthcare billing experience, with hospice billing strongly preferred.
- High school diploma or equivalent required
- Strong analytical skills and attention to detail with the ability to manage multiple billing cycles simultaneously.
- Proficiency in Microsoft Office and billing software systems.
Nice to Have
- Associate’s degree in Healthcare Administration, Business, or related field preferred.
