Billing Specialist

The Billing Specialist is responsible for accurate and timely processing of all claims, monthly billing and the collection and research of outstanding accounts receivable. This role ensures compliance with payer requirements and agency policies while supporting optimal reimbursement. Experience in Home Care billing and Article 28 is required. Experience with Home Care Home Base, Medent and HHA Exchange is preferred but not required.

Performance Responsibilities and Standards:

Claims Management & Billing

• Review and analyze claims for accuracy and completeness; obtain or correct missing or inaccurate information related to Home Health and Primary Care billing (PDGM, episodic, professional, institutional claims, and Article 28).
• Prepare and submit claims/invoices to appropriate payers and clients within established billing schedules.
• Ensure compliance with payer requirements, including Medicare, Medicaid, and commercial insurance guidelines.
• Utilize electronic billing systems and EDI software (e.g., Waystar) to submit and track claims,
• First-Pass Clean Claim Rate: = 95–98% of claims accepted by the payer on first submission without rejections or edits
• Run KPI’s monthly keep

Accounts Receivable & Collections

• Monitor accounts receivable and perform timely follow-up on outstanding claims and invoices.
• Research, resolve, and appeal unpaid or denied claims to maximize reimbursement.
• Maintain accurate documentation of all billing and collection activities.
• AR >120 Days: Maintain = 10% of total accounts receivable balance aged over 120 days

Payment Posting & Reconciliation

• Post payments accurately and in a timely manner, maintaining a high level of accuracy, within 24 hours of receipt
• Identify and resolve discrepancies timely related to payments and billing.

Communication & Collaboration

• Communicate billing, payment, and collection issues to the Billing Manager on an ongoing basis.
• Collaborate with internal teams to resolve billing issues and improve processes.
• Provide courteous, responsive, and professional customer service to clients, payers, and staff.

Systems & Compliance

• Utilize IT systems to perform job duties efficiently.
• Adhere to all agency policies, procedures, and regulatory requirements.
• Maintain current knowledge of Home Care and Primary Care billing practices and regulations.

Professional Development & Team Participation

• Attend required meetings, trainings, and workshops.
• Foster open communication and contribute to a team-oriented work environment.
• Support agency initiatives related to planning and problem-solving.

Qualifications & Requirements

• Minimum of 1–2 years of medical billing experience, preferably in home care.
• Strong knowledge of revenue cycle management and accounts receivable processes.
• Experience with PDGM, episodic billing, and institutional claims.
• Familiarity with Medicare, Medicaid, and commercial insurance guidelines.
• Experience with electronic billing systems and EDI platforms (e.g., Waystar) preferred.
• Proficiency in Home Care Home Base and HHA Exchange preferred.
• Excellent organizational, communication, and problem-solving skills.
• Strong attention to detail and accuracy.
• Dependable with a strong work ethic.
• Commitment to excellent customer service.
• Compliance with all agency policies and procedures.

Physical Requirements:

• Ability to communicate effectively, including speaking, hearing, and visual comprehension of written and verbal information.
• Ability to sit or stand for extended periods (up to 90% of the workday).
• Bloodborne Pathogens Exposure Category III: Minimal risk; rare exposure to blood or body fluids.

Compensation & Benefits:

Competitive Salary [This position is an H05 non-exempt position with a min-max rate of: $17.09-$25.64/hour] with:

• Retention Bonuses
• Internal Mentoring Program
• 401K with generous Employer match
• On-Site Gym (free for all employees)
• Medical, Dental, Vision plans
• Tuition Reimbursement
• Partially funded HSA
• Employee Recognition Platform
• Paid Time Off, Holidays, Sick and Extended Sick Leave
• Short/Long term Disability
• Employee Assistance Program (EAP)
• Much More!

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About Nascentia Health:

Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.

Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.

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Nascentia Health is an Equal Opportunity Employer (EOE)

Employment is contingent upon negative results of a pre-hire drug screen and background check clearance