Quality and Billing Specialist

Goodwin Living•Alexandria, VA

About The Position

The Hospice Quality and Billing Specialist is responsible for supporting hospice operations through oversight of quality/compliance processes and accurate coordination of billing functions. This role works closely with clinical, admissions, and finance teams to ensure documentation meets regulatory requirements, claims are processed timely, and quality metrics are monitored to support agency performance and compliance.

Requirements

Minimum of 2 years hospice experience required.
Knowledge of Medicare hospice regulations and billing requirements.
Strong understanding of hospice documentation requirements and LCD guidelines.
Proficient in Microsoft Office, Excel, and reporting tools.
Strong organizational, analytical, and communication skills.
Ability to manage multiple priorities in a fast-paced environment.

Nice To Haves

Associate’s or Bachelor’s degree preferred.
Experience with hospice billing, quality, or compliance strongly preferred.
Experience with EMR systems such as WellSky preferred.

Responsibilities

Monitor hospice documentation for regulatory compliance with CMS, CHAP, and agency standards.
Conduct routine chart audits for CTIs, Face-to-Face encounters, Plans of Care, visit documentation, eligibility documentation, and LCD compliance.
Assist with QAPI data collection, tracking, and reporting.
Track and trend hospitalizations, live discharges/revocations, missed visits, CAHPS opportunities, and documentation timeliness.
Support ADR/TPE audit preparation and tracking.
Collaborate with leadership to identify compliance risks and recommend corrective actions.
Assist with education and follow-up related to documentation deficiencies.
Maintain audit logs, compliance trackers, and regulatory records.
Review claims for accuracy prior to billing submission.
Verify required documentation is complete before claims release, including NOEs, CTIs, Face-to-Face encounters, visit completion, and physician signatures.
Monitor claim status and follow up on rejections, RTPs, denials, and unpaid claims.
Coordinate with billing vendors, Medicare, Medicaid, and commercial payers as needed.
Assist with monthly billing close processes and revenue tracking.
Review eligibility and payer authorizations.
Support timely filing compliance and payment reconciliation.
Track ADRs, denials, appeals, and billing trends.
Generate billing and operational reports for leadership review.
Work closely with Clinical Managers, Admissions, Billing/Finance, Compliance, and Medical Records.
Participate in quality and operational meetings.
Assist with implementation of workflow improvements and process standardization.
Support onboarding and education related to documentation and billing processes.