Hospice Medicaid RC Specialist

Lifecare Home Health Family•Irving, TX

5d•Hybrid

About The Position

Position Summary: The Hospice RC Specialist is responsible for managing, reviewing, validating and coordinating all Room & Board, GIP/Respite invoicing for hospice operations. This role ensures accurate billing, timely payments, strong vendor relationships, and compliance with Medicare and Medicaid billing standards. This position ensures that company’s claims billed to payors are processed in compliance with the States Medicaid and Managed Care Organization (MCO) regulations, verify patient eligibility, monitor authorizations, resolve denied claims, and support the financial operations of the hospice organization. The Specialist serves as a key point of communication between hospice agencies, vendors, clients and will report directly to the Director of Revenue Cycle Management.

Requirements

High school diploma or equivalent
Minimum 2 years medical billing experience related to room & board, long-term care, managed care hospice billing.
Familiarity with hospice levels of care; routine home care, respite and continuous care and general inpatient (GIP)
Strong knowledge of Medicaid billing guidelines, coding, and reimbursement processes.
Excellent communication skills and ability to work collaboratively with facility partners and internal teams.
Strong attention to detail and accuracy.
Working knowledge of Wellsky/Consolo EMR, including navigation, documentation review and extracting billing -related data.

Responsibilities

Verify that patient benefit periods, levels of care, and election information are correct prior to billing.
Prepare, submit, and track Medicaid room and board charges according to state and federal guidelines, including rate changes and patient liability.
Manage all aspects of Room & Board invoicing for assigned hospice agencies to include verifying correct R&B billing rates and invoice accuracy.
Review, update, validate and approve GIP/Respite invoices and prepare for AP processing.
Monitor claim status, follow up on unpaid Medicaid or denied claims, and assist with actions required to correct claims as needed
Maintain accurate records of all claims, payments, and adjustments
Verify resident eligibility and enrollment in Medicaid programs such as managed care plans or traditional Medicaid at admission and regular intervals throughout a patient’s benefit period.
Obtain authorizations according to payor/plan requirements by State, plan enrollment, managed care assignments, and facility contracts.
Coordinate with admissions, clinical teams, social workers, and facility partners to ensure accurate billing information.
Identify discrepancies and work with facility partners or internal departments to resolve them.
Communicate effectively with clients, vendors and internal teams, including corporate billing and agency leadership.
Participate in internal meetings, team discussions as requested.
Perform other related duties as assigned or incidental to the essential functions of the position.