Pre-Bill Specialist

The Pennant Group

About The Position

The Pre‑Bill Review Specialist is responsible for conducting comprehensive audits of patient charts prior to claim submission. This role ensures that all required documentation, authorizations, visit notes, orders, and payer‑specific elements are complete, compliant, and correctly aligned with billing requirements. As a critical part of the revenue cycle, this position helps prevent denials, accelerate reimbursement, and safeguards regulatory compliance across Home Health and Hospice programs.

Requirements

Minimum of 1 year of experience in Home Health or Hospice documentation review, QA, billing, or coding.
Understanding Medicare, Medicaid, Government, and Commercial payer documentation requirements.
Experience working within an EMR and familiarity with workflow queues, chart audits, and documentation compliance.
Knowledge of corporate business management and governmental regulations
Demonstrates good communication skills and public relations skills.
Exceptional attention to detail and strong commitment to documentation accuracy.
Ability to identify compliance issues and communicate them clearly and professionally.
Highly organized with the ability to manage multiple charts and deadlines simultaneously.
Strong critical thinking skills to evaluate chart completeness and identify potential issues before claims are submitted.
Collaborative and proactive approach to working with clinical and billing teams.
Ethical and compliance driven mindset.

Nice To Haves

Prior experience conducting prebilling or QA reviews in a Home Health or Hospice setting.
Familiarity CMS requirements for Home Health and Hospice admissions, signed orders compliance, regulatory forms and criteria for compliant billing.
Use of Home Care Home Base (HCHB) EMR, Mosai (formerly known as Forcura) e-fax portal.

Responsibilities

Perform detailed pre billing audits on all Home Health and Hospice charts to verify documentation completeness and accuracy.
Confirm all visit notes, supervisory notes, plans of care, OASIS assessments, certifications, and recertifications are signed, dated, and compliant with payer and regulatory requirements.
Completes an administrative record audit following patient discharge or prior to billing and forwards abnormal results to the Clinical Director or their designee for clinical audit.
Supervises the use of the clinical records information system and maintains a comprehensive working knowledge of the system including upgrades and enhancements.
Validate patient eligibility, insurance coverage, and authorization requirements prior to claim release.
Ensure authorizations are active and applicable to the dates, disciplines, and service types billed.
Identify missing or non-compliant documentation and collaborate with clinical teams to resolve deficiencies prior to billing.
Ensure all documentation adheres to federal and state regulations, Medicare/Medicaid requirements, and internal policies.
Ensures clinical record systems are maintained in compliance with state, federal and regulations.
Maintains comprehensive working knowledge of state, federal regulations and serves as a resource for appropriate organization personnel.
Work closely with clinical, scheduling, and billing teams to resolve documentation gaps that may delay claim submission.
Provide timely feedback and clarification on documentation discrepancies to ensure efficient workflow.
Communicates effectively, professionally, and thoroughly with staff regarding coordination of care expectations, educates and enforces deadlines, and establishes and maintains positive working relationships with current staff and contract staff.
Maintain current knowledge of Home Health and Hospice regulatory requirements, and payer‑specific pre‑billing criteria.
Verify that documentation supports the codes, service lines, frequencies, and episodes billed.