Billing Lead

BILLING LEAD – HOME HEALTH & HOSPICE 

POSITION SUMMARY: The Billing Lead is responsible for the daily leadership of the team that handles all billing functions for our home health and hospice services. This is a hands-on leadership role that requires expert knowledge of Medicare, Medicaid, and commercial billing regulations, a commitment to low denial rates, and efficient accounts receivable management. 

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: 

• Prepares, reviews, and accurately submits institutional claims (e.g., UB-04s/CMS-1450s) to Medicare, Medicaid, and all commercial insurance carriers via electronic submission. 

• Leads, trains, and mentors the billing team, setting performance goals, distributing workload, and providing mentorship to optimize accuracy and productivity. 

• Oversees the preparation, review, and compliant electronic submission of all claims (e.g., final claims, RAPs/NOEs, adjustments) to Medicare, Medicaid, and commercial payers. 

• Directs the team’s efforts in daily payment posting, reconciliation, and managing the accounts receivable aging to ensure low DSO (Days Sales Outstanding). 

• Implements and monitors processes for the prompt research, correction, and resubmission of denied and rejected claims, identifying and addressing root causes to improve first-pass acceptance rates. 

• Ensures all billing practices adhere strictly to CMS (Medicare), state Medicaid, and commercial payer guidelines, maintaining readiness for all internal and external audits. 

• Maintains expert-level knowledge of current billing rules, including the home health Patient-Driven Groupings Model (PDGM) and hospice payment system, ensuring correct revenue codes and payment calculations are used. 

• Works closely with the Intake and Authorization teams to resolve eligibility or authorization-related billing hurdles, and with Clinical Documentation to ensure charts support the services billed. 

• Other appropriate services and special projects as assigned. 

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description. 

QUALIFICATIONS & REQUIREMENTS FOR THE POSITION: 

• Minimum of four (4) years of experience in healthcare medical billing, with at least two (2) years specifically in home health or hospice billing. 

• Minimum of one (1) year of leadership or supervisory experience managing a billing or accounts receivable team. 

• Expert proficiency with a major home health or hospice EMR and Billing system (e.g., HCHB, Kinnser/WellSky, MatrixCare). 

• Comprehensive knowledge of ICD-10 coding, CPT codes, and all institutional claim forms (UB-04/CMS-1450). 

• Deep understanding of Medicare and Medicaid billing regulations for home health and hospice services. 

PREFERRED KNOWLEDGE AND SKILLS:   

• Associate's or Bachelor's degree in Business, Accounting, Finance, or a related field. 

• Certification in Medical Billing and Coding (e.g., CPC, COC). 

• Exceptional analytical skills with a strong aptitude for numbers and detailed data analysis. 

• Proven ability to troubleshoot complex billing issues and manage high-volume transactional workloads. 

• Excellent written and verbal communication skills for effective communication with payers, staff, and management. 

• High level of professionalism and integrity with a focus on regulatory compliance. 

• Proactive problem-solver with a focus on continuous process improvement. 

SUPERVISORY RESPONSIBILITIES: 

• May supervise the team that handles all billing functions for home health and hospice services.