Revenue Compliance Analyst - Home Health and Hospice

• Perform targeted and periodic audits in Home Health and Hospice agencies with high error rates or financial risk.
• Ensure clinical documentation supports medical necessity, level of care, and accuracy of coding (ICD-10, CPT, HHRG, HIPPS, etc.).
• Confirm Home Health documentation meets:
• Face-to-Face Encounter requirements
• OASIS data accuracy
• Plan of Care (POC) compliance
• Validate Hospice documentation for:
• Accurate certification of terminal illness
• Appropriately documented decline and prognosis
• Correct election and level of care per Medicare guidelines and LCDs
• Review claim submissions, denials, and appeals to identify trends and recommend corrective actions.
• Provide detailed feedback post-audit and support ongoing documentation improvement.

• Complete and review:
• Additional Documentation Requests (ADRs)
• Appeals
• Quality of Care (QOC) reviews
• Risk Analyses (RA) from Medicare and Managed Care Payers
• Draft Medical Necessity summaries and ensure timely and accurate submission of:
• Home Health RAPs and Final Claims
• Hospice NOEs, NOTRs, and Final Claims
• Monitor and track the outcomes of all appeal and audit activity.
• Coordinate and respond to government and payer probes; assist with education and corrective action planning.

• Collaborate with the Compliance Department to conduct internal audits and identify areas for improvement.
• Assist in the training of clinical and billing teams on compliance standards, PDGM, and Medicare Hospice Benefit requirements.
• Maintain open, professional communication with internal staff, leadership, payers, and regulatory bodies.
• Deliver feedback, reports, and recommendations to the Revenue Compliance Manager and executive leadership.

• Maintain accurate records of all audits and appeal activity.
• Submit reports regularly to the Revenue Compliance Manager, VP of Home Care-Based Services, and other leadership as needed.
• Conduct in-depth regulatory research related to payment policy, CMS updates, and payer requirements.

• Licensure: RN, LVN, OTR, PT, or SLP

• Minimum 5 years of clinical experience in post-acute care, including Home Health and Hospice
• Experience with PDGM, OASIS, Hospice Conditions of Participation, Medicare documentation and billing
• Certification:
• Coding certification required (e.g., CRC, CCS, CPC, HCS-D, HCS-H)

• Bachelor’s, Master’s, or Doctorate in a healthcare or clinical field preferred (or equivalent experience)

• Strong understanding of CMS Conditions of Participation for SNF, Home Health, and Hospice
• Proficient with Medicare billing, compliance requirements, and denial managements

• RAC-CT Certification via AANAC
• ICD-10 Coding Boot Camps
• PDGM and Hospice regulatory training courses
• Medicare and RAC Audit Seminars
• CMS Open Forums on Denials, Appeals, and Documentation Standards

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.

Diversity, Equity and Inclusion are at the heart of Pivot Rehab. We are committed to a culture that respects our differences and values the contribution of all people.

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