Benefits:

Competitive salary

Flexible schedule

Opportunity for advancement

Benefits/Perks

Competitive Compensation

Great Work Environment

Career Advancement Opportunities

Job Summary

The Home Health Medical Biller is responsible for accurately managing the billing cycle for home health services, ensuring timely submission of claims, and securing optimal reimbursement from Medicare, Medicaid, and commercial insurance plans. This role includes verifying patient eligibility, reviewing clinical documentation, coding diagnoses and services, resolving claim denials, following up on outstanding balances, and maintaining strict compliance with federal, state, and payer-specific regulations. The biller collaborates closely with clinicians, intake, quality assurance, and authorization teams to ensure clean claims and accurate billing. Strong attention to detail, proficiency with EMR and clearinghouse systems, and the ability to communicate effectively with payers and internal staff are essential for success in this role.

Responsibilities

Verify patient insurance eligibility, benefits, and authorization requirements prior to billing

Review OASIS, plan of care, visit notes, and all clinical documentation to ensure accuracy before claim submission

Assign appropriate ICD-10 diagnosis codes and HCPCS/CPT codes based on clinical documentation and payer guidelines

Prepare, submit, and track claims through EMR and clearinghouse systems such as Waystar, or Inovalon

Monitor claim status and promptly address rejections, denials, and required corrections

Communicate with insurance companies to resolve billing discrepancies and ensure timely reimbursement

Follow up on unpaid or underpaid claims and maintain accurate aging reports

Ensure compliance with Medicare, Medicaid, MassHealth, and commercial payer billing regulations

Collaborate with intake, QA, authorization, and clinical teams to maintain clean and complete claims

Update billing records, maintain organized documentation, and prepare financial or billing reports as needed

Protect patient confidentiality and follow HIPAA requirements

Provide billing support during audits, recertifications, or payer reviews

Assist with improvement of billing workflows and recommend process enhancements to reduce claim errors and increase reimbursement

Qualifications

Associate’s degree in Healthcare Administration, Billing, or related field preferred

Minimum 1–2 years of medical billing experience, preferably in home health or a similar healthcare setting

Strong knowledge of Medicare, Medicaid/MassHealth, and commercial insurance billing requirements

Familiarity with ICD-10 coding, HCPCS, CPT codes, and documentation guidelines

Experience using EMR systems and clearinghouses (e.g., Axxess, Finale, Waystar, Availity, Inovalon)

Ability to analyze claim denials, correct errors, and follow through with payer resolution

Strong understanding of authorization processes and insurance eligibility verification

Excellent attention to detail and accuracy in data entry

***** YOU NEED TO LIVE IN MASSACHUSETTS OR NEW HAMPSHIRE***** IN OFFICE JOB *****