Hospice Biller and Contract Specialist

Job Title: Hospice Biller and Contracting Specialist

Job Summary: The Hospice Biller and Contracting Specialist is responsible for overseeing the billing and reimbursement processes for hospice services, as well as managing contracts with insurance providers, government agencies, and other third-party payers. This role requires in-depth knowledge of hospice care billing codes, insurance protocols, and contract management to ensure accurate payment and compliance with all federal, state, and insurance regulations.

Key Responsibilities:

• Billing and Reimbursement:
• Process and submit claims to insurance companies, Medicare, Medicaid, and other third-party payers for hospice services.
• Review patient files to ensure all necessary documentation and coding is accurate for proper billing.
• Track and follow up on outstanding claims, ensuring timely reimbursement.
• Research and resolve billing discrepancies or denials in coordination with insurance providers.
• Ensure compliance with Medicare, Medicaid, and commercial insurance billing regulations.
• Maintain accurate records of all submitted claims and payment history.
• Contract Management:
• Negotiate, review, and maintain contracts with insurance providers, healthcare networks, and other third-party payers.
• Ensure that all contracts are compliant with federal, state, and local regulations.
• Coordinate with legal and compliance teams to ensure contract terms align with hospice billing practices.
• Review and update contract terms regularly to ensure reimbursement rates and terms are competitive and favorable for the hospice organization.
• Documentation and Compliance:
• Ensure all billing processes adhere to industry standards and hospice care regulations.
• Assist with audits and prepare necessary documentation for billing reviews.
• Stay current on updates to billing codes, procedures, and government regulations related to hospice care.
• Provide training to clinical and administrative teams regarding billing processes and contract requirements.
• Customer Service and Communication:
• Act as a liaison between hospice providers, patients, families, and insurance companies to resolve billing and payment issues.
• Address any billing-related inquiries from patients, families, and insurance representatives in a professional and timely manner.
• Reporting and Analytics:
• Prepare regular reports on billing activities, revenue cycle metrics, and contract performance.
• Monitor key performance indicators (KPIs) to identify trends and areas for improvement in the billing and contracting processes.

Qualifications:

• Education: High school diploma or equivalent required. Associate’s degree or higher in Business Administration, Healthcare Management, or related field preferred.
• Experience:
• At least 2-3 years of experience in healthcare billing, preferably in hospice care.
• Experience with Medicare, Medicaid, and private insurance billing practices.
• Previous experience with healthcare contracting, including negotiating terms and managing agreements.
• Skills:
• Knowledge of hospice billing codes (e.g., ICD-10, HCPCS, CPT).
• Strong attention to detail and accuracy in data entry and documentation.
• Excellent communication and interpersonal skills.
• Familiarity with billing software and electronic health records (EHR) systems.
• Ability to problem-solve and work independently.

Preferred Skills:

• Certification in Medical Billing and Coding (e.g., CPC, CBCS).
• Knowledge of hospice-specific billing requirements and reimbursement structures.
• Experience with negotiation and contract management in the healthcare industry.

Physical Requirements:

• Ability to sit for extended periods and work at a computer.
• Occasional lifting of documents or office supplies up to 10 pounds.

Working Conditions:

• Typically works in an office setting.
• Some remote work opportunities may be available, depending on company policy.

Job Type: Full-time

Pay: $70,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person

Salary : $70,000 - $75,000