Billing Representative (Hospice)

Essential

Duties

and

Responsibilities

Hospice

and

Medicare

Billing

Process

and

submit

hospice-related

claims

in

accordance

with

• Medicare,
• Medicaid,

and

payer

billing

guidelines.

Submit

claims

with

appropriate

modifiers,

including

the

GW

modifier

for

services

determined

to

be

unrelated

to

the

patient's

terminal

hospice

diagnosis.

Review

claim

submissions

for

accuracy

and

completeness

prior

to

billing.

Verify

payer

information

and

billing

requirements

to

ensure

correct

claim

routing

and

reimbursement.

Denial

Management

and

Claims

Resolution

• Research,
• analyze,

and

resolve

B9

denial

claims.

Submit

claims

to

the

appropriate

hospice

payer

for

reimbursement

when

required.

Document

all

denial

resolution

activities

and

payer

communications

within

the

billing

system.

Related

vs.

Unrelated

Service

Determinations

Review

hospice

and

skilled

nursing

facility

correspondence,

medical

documentation,

and

supporting

records

to

determine

whether

services

are

related

or

unrelated

to

the

patient's

hospice

diagnosis.

Coordinate

with

hospice

providers

and

clinical

staff

to

obtain

supporting

documentation

for

determination

decisions.

Maintain

documentation

supporting

billing

and

reimbursement

decisions.

Ensure

proper

financial

responsibility

is

assigned

based

on

determination

outcomes.

Skilled

Nursing

Facility

and

Client

Billing

Ensure

hospice

facilities

that

order

services

receive

accurate

and

timely

charges

on

client

invoices.

Bill

charges

back

to

skilled

nursing

facilities

when

services

are

determined

to

be

the

financial

responsibility

of

the

facility.

Ensure

all

billable

services

are

invoiced

appropriately.

Maintain

timely

turnaround

of

bill-back

activities

with

proper

invoice

notes

to

support

revenue

cycle

goals.

Documentation

and

Compliance

Ensure

• detailed,
• accurate,

and

compliant

account

notes

are

entered

into

the

billing

system

for

all

billing

activities,

claim

status

updates,

payer

• communications,
• denials,

and

reimbursement

actions.

Maintain

complete

audit

trails

within

billing

systems

to

support

claim

processing

and

reimbursement

• validation.
• Save,
• organize,

and

retain

supporting

documentation,

including

medical

records,

hospice

correspondence,

payer

notices,

denial

letters,

and

determination

documentation

in

accordance

with

company

policies

and

regulatory

requirements.

Ensure

required

documentation

is

properly

attached

and

maintained

for

compliance

and

audit

readiness.

Review

documentation

for

completeness

and

accuracy

prior

to

claim

• submission,
• invoicing,

and

reimbursement

processing.

Support

internal

and

external

audits

by

providing

requested

documentation

and

claim

history

records.

Adhere

to

all

• CMS,
• HIPAA,
• Medicare,

and

organizational

compliance

requirements.

Revenue

Cycle

Support

Collaborate

with

billing

• leadership,
• hospices,
• facilities,
• payers,

Sales

Teams,

and

internal

departments

to

improve

operational

efficiency

and

reimbursement

outcomes.

Maintain

• productivity,
• quality,

and

compliance

standards

established

by

management.

Additional

Responsibilities

Foster

a

collaborative

team

environment

by

supporting

coworkers,

sharing

best

practices,

and

contributing

to

department

goals

and

success.

Perform

other

related

• duties,
• projects,

and

responsibilities

as

assigned

by

management.

This job description

is

not

intended

to

be

an

exhaustive

list

of

all

• duties,
• responsibilities,

or

qualifications

associated

with

the

position.

Responsibilities

may

be

• added,
• modified,

or

reassigned

based

on

business

needs

and

organizational

requirements.

Qualifications

Education

High

School

Diploma

or

GED

required.

Experience

Minimum

of

2-3

years

of

healthcare

billing

experience

required.

Experience

with

Medicare

claims

processing,

billing

to

appropriate

hospice

payers,

denial

management,

and

reimbursement

recovery

preferred.

Experience

working

with

skilled

nursing

facilities

and

hospice

providers

preferred.

Hospice

billing

experience

is

a

plus

but

not

• required.
• Knowledge,
• Skills,

and

Abilities

Strong

knowledge

of

Medicare

hospice

billing

regulations

and

reimbursement

guidelines.

Understanding

of

GW

modifier

requirements

and

hospice-related

billing

practices.

Knowledge

of

B9

denial

processing

and

claims

resolution

procedures.

Experience

billing

and

submitting

claims

to

the

appropriate

hospice

payer.

Ability

to

interpret

medical

documentation

and

determine

related

versus

unrelated

hospice

services.

Strong

understanding

of

healthcare

billing

and

revenue

cycle

principles.

Knowledge

of

HIPAA,

CMS

regulations,

and

compliance

requirements.

Excellent

• analytical,
• organizational,

and

problem-solving

skills.

Excellent

customer

service

and

interpersonal

skills.

Ability

to

communicate

professionally

and

effectively

with

external

customers,

internal

customers,

hospice

providers,

skilled

nursing

• facilities,
• clients,

and

Sales

Teams.

Strong

written

and

verbal

communication

skills.

Must

be

a

team

player

with

the

ability

to

collaborate

effectively

across

departments,

support

team

initiatives,

share

knowledge,

and

contribute

to

a

positive

work

environment.

Demonstrated

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

workload

and

meet

deadlines

in

a

fast-paced

environment.