Billing Representative (Hospice)

Process and submit hospice-related claims in accordance with Medicare, Medicaid, and payer billing guidelines.

Submit claims with appropriate modifiers, including the GW modifier for services determined to be unrelated to the patient's terminal hospice diagnosis.

Review claim submissions for accuracy and completeness prior to billing.

Verify payer information and billing requirements to ensure correct claim routing and reimbursement.

Research, analyze, and resolve B9 denial claims.

Submit claims to the appropriate hospice payer for reimbursement when required.

Document all denial resolution activities and payer communications within the billing system.

Review hospice and skilled nursing facility correspondence, medical documentation, and supporting records to determine whether services are related or unrelated to the patient's hospice diagnosis.

Coordinate with hospice providers and clinical staff to obtain supporting documentation for determination decisions.

Maintain documentation supporting billing and reimbursement decisions.

Ensure proper financial responsibility is assigned based on determination outcomes.

Ensure detailed, accurate, and compliant account notes are entered into the billing system for all billing activities, claim status updates, payer communications, denials, and reimbursement actions.

Maintain complete audit trails within billing systems to support claim processing and reimbursement validation.

Save, organize, and retain supporting documentation, including medical records, hospice correspondence, payer notices, denial letters, and determination documentation in accordance with company policies and regulatory requirements.

Ensure required documentation is properly attached and maintained for compliance and audit readiness.

Review documentation for completeness and accuracy prior to claim submission, invoicing, and reimbursement processing.

Support internal and external audits by providing requested documentation and claim history records.

Adhere to all CMS, HIPAA, Medicare, and organizational compliance requirements.

Collaborate with billing leadership, hospices, facilities, payers, Sales Teams, and internal departments to improve operational efficiency and reimbursement outcomes.

Maintain productivity, quality, and compliance standards established by management.

High School Diploma or GED required.

Minimum of 2-3 years of healthcare billing experience required.

Experience with Medicare claims processing, billing to appropriate hospice payers, denial management, and reimbursement recovery preferred.

Experience working with skilled nursing facilities and hospice providers preferred.

Hospice billing experience is a plus but not required.