Billing Representative (Hospice)

TridentCare•,

About The Position

The Billing Representative (Hospice) is responsible for processing and submitting hospice-related claims, managing denials, determining related vs. unrelated services, and ensuring accurate client billing. This role requires a strong understanding of Medicare, Medicaid, and payer billing guidelines, as well as excellent analytical and communication skills to collaborate with various internal and external stakeholders and support the revenue cycle.

Requirements

High School Diploma or GED required.
Minimum of 2-3 years of healthcare billing experience required.
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.

Nice To Haves

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.

Responsibilities

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.
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.
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.
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.
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.
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.
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.