Pre-Bill Specialist

The Pennant Group•Synergy Shared Services-TX-Remote, TX

About The Position

The Pre-Bill Specialist conducts comprehensive audits of patient charts before claim submission for Home Health and Hospice programs. The role ensures required documentation, authorizations, visit notes, orders, and payer-specific elements are complete, compliant, and aligned with billing requirements. This position supports clean claims, timely reimbursement, and regulatory compliance by identifying and resolving documentation issues before billing. The specialist also verifies patient eligibility, insurance coverage, and authorization requirements; maintains knowledge of clinical record systems and applicable regulations; and works with clinical, scheduling, and billing teams to resolve documentation gaps and support efficient workflows.

Requirements

At least 1 year of experience in Home Health or Hospice documentation review, quality assurance, billing, or coding.
Understanding of 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.
Good communication and public relations skills.
Exceptional attention to detail and commitment to documentation accuracy.
Ability to identify compliance issues and communicate them clearly and professionally.
Strong organizational skills and 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 pre-billing or quality assurance reviews in a Home Health or Hospice setting.
Familiarity with CMS requirements for Home Health and Hospice admissions, signed-order compliance, regulatory forms, and compliant billing criteria.
Experience using the Home Care Home Base (HCHB) EMR and Mosai (formerly Forcura) e-fax portal.

Responsibilities

Perform detailed pre-billing audits of Home Health and Hospice charts to verify documentation completeness and accuracy.
Confirm that visit notes, supervisory notes, plans of care, OASIS assessments, certifications, and recertifications are signed, dated, and compliant with payer and regulatory requirements.
Complete administrative record audits following patient discharge or before billing, and forward abnormal results to the Clinical Director or designee for clinical audit.
Supervise use of the clinical records information system and maintain working knowledge of its features, upgrades, and enhancements.
Validate patient eligibility, insurance coverage, and authorization requirements before claim release.
Ensure authorizations are active and applicable to the dates, disciplines, and service types being billed.
Identify missing or noncompliant documentation and collaborate with clinical teams to resolve deficiencies before billing.
Ensure documentation and clinical record systems comply with applicable federal and state regulations, Medicare and Medicaid requirements, and internal policies.
Maintain knowledge of state and federal regulations and serve as a resource for appropriate organization personnel.
Coordinate with clinical, scheduling, and billing teams to resolve documentation gaps that could delay claim submission.
Provide timely feedback and clarification about documentation discrepancies.
Communicate coordination-of-care expectations, educate staff about deadlines, enforce deadlines, and maintain positive working relationships with current 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.