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.