Billing Manager For Home Health

Brockton Home Health Care Agency•Brockton, MA

6d•Onsite

About The Position

Brockton Home Health Care Agency is seeking an experienced and detail-oriented Billing Manager to manage the agency’s day-to-day billing and claims activities. The Billing Manager is responsible for preparing, reviewing, and submitting accurate claims to Medicare, MassHealth/Medicaid, managed care organizations, and other contracted payers. This position will also research rejected and denied claims, correct billing errors, submit corrected claims and appeals when appropriate, monitor outstanding accounts receivable, and follow claims through final resolution. The primary goal of this position is to ensure that all properly authorized and documented services are billed accurately and on time, and that every unpaid, rejected, or denied claim receives appropriate follow-up.

Requirements

Previous healthcare billing experience required.
Experience submitting and correcting electronic healthcare claims.
Experience researching claim denials and rejections.
Knowledge of accounts receivable and revenue-cycle processes.
Understanding of prior authorizations and insurance eligibility.
Familiarity with EOBs, ERAs, claim status, and denial codes.
Understanding of timely-filing requirements.
Ability to navigate payer portals and clearinghouses.
Strong computer and spreadsheet skills.
Strong mathematical and reconciliation skills.
Excellent attention to detail.
Strong problem-solving and research skills.
Ability to manage multiple claims and deadlines simultaneously.
Strong written and verbal communication skills.
Ability to work independently and maintain organized records.
Ability to protect confidential patient and financial information.

Nice To Haves

Home health billing experience strongly preferred.
Knowledge of Medicare and Medicaid/MassHealth billing preferred.
Experience with managed care billing preferred.
Massachusetts home health billing
Medicare home health billing
MassHealth billing
Managed care organizations
Medicare Advantage plans
Medicaid managed care
Prior authorization management
Claim appeals
Revenue-cycle management
A/R recovery
Electronic clearinghouses and payer portals

Responsibilities

Prepare and submit claims accurately and within required payer deadlines.
Review claims before submission for completeness and accuracy.
Verify patient/member demographics, insurance information, dates of service, authorization, units, service codes, modifiers, and other required billing information.
Submit electronic and manual claims as required by individual payers.
Ensure claims are accepted by the payer or clearinghouse after submission.
Correct rejected claims promptly and resubmit them.
Prevent duplicate or inappropriate billing.
Maintain documentation of claim submission and correction activity.
Take ownership of denied and rejected claims from identification through resolution.
Research the specific reason for each denial.
Determine whether the issue relates to authorization, eligibility, coding, documentation, timely filing, payer processing, or another cause.
Correct billing errors and resubmit claims promptly.
Prepare reconsiderations or appeals when appropriate.
Contact insurance companies and payer representatives when additional research is necessary.
Track denials until payment or final resolution.
Maintain a denial log showing the claim, dollar amount, payer, denial reason, corrective action, responsible party, and status.
Identify recurring denial patterns and report them to management.
Recommend corrective actions to prevent repeated denials.
Verify that services requiring authorization have a valid PA covering the correct member, service type, dates of service, authorized units/hours/visits, frequency, and applicable billing code.
Immediately report missing, expired, insufficient, or incorrect authorizations to the appropriate department.
Do not knowingly submit claims for services that do not meet applicable authorization requirements without appropriate management review.
Verify insurance eligibility and payer information as required before claim submission.
Identify changes in coverage, terminated eligibility, secondary insurance, payer changes, or other issues that may affect billing.
Communicate eligibility problems promptly so they can be resolved before they result in unnecessary denials.
Work closely with the Clinical Manager and clinical staff to ensure required documentation is available to support billing.
Identify services that cannot be billed because of missing visit notes, incomplete documentation, missing signatures, documentation submitted late, authorization discrepancies, plan-of-care issues, or other billing-related documentation deficiencies.
Track held claims until the issue has been corrected.
Never create, alter, backdate, or improperly modify clinical documentation to support a claim.
Monitor outstanding accounts receivable and follow up on unpaid claims.
Review A/R aging, including 0–30 Days, 31–60 Days, 61–90 Days, 90+ Days.
Prioritize high-dollar and aging claims.
Research why claims remain unpaid and take appropriate follow-up action.
Document payer calls, claim status, reference numbers, corrective actions, and expected next steps.
Escalate significant or unresolved payer issues to management.
Maintain awareness of payer-specific claim filing and appeal deadlines.
Monitor unbilled and denied claims approaching timely-filing limits.
Take appropriate action before deadlines whenever possible.
Immediately notify management when a claim is at risk of becoming uncollectible because of a filing or appeal deadline.
Review EOBs, ERAs, remittance advice, and payer correspondence as assigned.
Identify denials, partial payments, underpayments, overpayments, recoupments, adjustments, incorrect contractual reductions, and claims paid incorrectly.
Research discrepancies and initiate appropriate follow-up.
Communicate professionally with Medicare, MassHealth/Medicaid, managed care organizations, commercial insurers, clearinghouses, and other payers as necessary.
Maintain documentation of payer communications and reference numbers.
Follow unresolved claims through completion rather than simply documenting that a payer was contacted.
Prepare a monthly denial report identifying total number and dollar amount of denials, denials by payer, primary denial reasons, authorization-related denials, eligibility-related denials, documentation-related denials, timely-filing denials, corrected/resubmitted claims, appeals submitted, claims recovered, and claims still outstanding.
Notify management when recurring problems indicate a process, clinical, payer, or billing-system issue.
Maintain billing practices consistent with applicable payer requirements, agency policies, and federal and Massachusetts healthcare program requirements.
Never knowingly submit a claim for a service not provided, submit unsupported claims, falsify or alter documentation, intentionally bill incorrect units or services, duplicate bill, or change service information solely to obtain payment.
Report suspected overpayments, duplicate payments, inappropriate billing, or other significant billing discrepancies promptly to the Administrator.
Maintain the confidentiality and security of patient/member information, financial information, payer information, passwords, and agency records.
Follow HIPAA requirements and Brockton Home Health Care Agency's privacy and security policies.