Billing Specialist - Home Health/Hospice

**About Us:**

Pathways Healthcare is a leading, physician- and nurse practitioner-led home health and hospice organization, committed to redefining recovery through comprehensive, patient-centered care. Our innovative Medical Rehabilitation Program offers a meaningful alternative to institutional rehab, helping people heal at home, with dignity and purpose.

As one of the first home health agencies to adopt AI-assisted documentation, we're investing in tools that give our clinicians time back – saving **5 to 10 hours** per week! We have made a deliberate decision _not_ to raise our productivity expectations, so the patients __and__ clinicians win in the end. Technology handles the paperwork and your clinical judgment stays at the center of every note!

**We are proud to have ranked in** __Boston Globe's Top Places to Work in Massachusetts and USA Today's Best Places to Work in the United States since 2023!__

**Job Description:**

• Role: Billing Specialist - Home Health, Hospice & Part B
• Rate: $23-$26/hour
• Main Office location: Westwood, MA
• Schedule: Monday-Friday (8:30-5:00pm)
• Job Type: Full-Time

**Qualifications:**

_Required_

• High school diploma or equivalent.
• Previous healthcare billing, accounts receivable, claims, audit, or revenue cycle experience.
• Experience in **Home Health, Hospice, Medicare Part B, or another Medicare-focused healthcare billing environment**.
• Strong understanding of healthcare reimbursement, insurance requirements, denials, and accounts receivable processes.
• Ability to review patient accounts and identify billing discrepancies or missing information.
• Ability to interpret EOBs, remittance advice, denial codes, claim status responses, and payer correspondence.
• Strong analytical and problem-solving skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple accounts and priorities while meeting deadlines.
• Ability to work independently and collaborate effectively across departments.
• Proficiency with Microsoft Office and healthcare billing or electronic medical record systems.

_Preferred_

• Home Health or Hospice revenue cycle experience.
• Medicare Part B billing or auditing experience.
• Knowledge of Medicare Home Health and Hospice billing requirements.
• Experience reviewing denials, underpayments, and aging accounts.
• Experience with Medicare Advantage, Medicaid, and commercial insurance plans.
• Experience with Homecare Homebase (HCHB), Inovalon, clearinghouses, or similar revenue cycle systems.
• Experience conducting billing audits or quality reviews.

**Responsibilitie****s:**

• Audit patient accounts for billing accuracy, completeness, and compliance with payer requirements.
• Review accounts prior to billing to identify missing documentation, authorization issues, eligibility concerns, coding discrepancies, or other billing barriers.
• Review billed accounts for potential errors, payment discrepancies, denials, underpayments, or follow-up needs.
• Audit billing notes, account activity, and supporting documentation to ensure appropriate follow-up has occurred.
• Review remittance advice, EOBs, claim status information, payer responses, and denial reasons.
• Research billing discrepancies and determine the appropriate next steps for resolution.
• Identify trends in billing errors, denials, documentation gaps, or payer issues and escalate recurring concerns.
• Work collaboratively with billing, prebill, intake, authorization, clinical, scheduling, and other departments to resolve account issues.
• Monitor assigned work queues, reports, or account lists to ensure outstanding issues are addressed timely.
• Review insurance changes and payer information for potential billing impact.
• Assist with aging reviews, account reconciliation, and identification of accounts requiring correction, appeal, adjustment, or additional follow-up.
• Ensure billing-related documentation and account notes are clear, complete, and accurate.
• Support internal audits and revenue cycle quality-improvement initiatives.
• Provide feedback and education to internal teams when recurring billing or documentation issues are identified.
• Maintain knowledge of Medicare, Medicaid, Medicare Advantage, commercial payer, Home Health, Hospice, and Part B billing requirements applicable to assigned responsibilities.
• Meet established productivity, accuracy, and account-resolution expectations.
• Perform additional revenue cycle and billing audit duties as assigned.

**What We Offer:**

• 3 weeks PTO annually accrued and 1 week paid sick time!
• Paid Federal Holidays (8 observed annually)
• 401(k) Retirement Plan with employer match
• Blue Cross Blue Shield Medical (Choice of HMO/PPO), Dental, Principal Vision and Life insurance

• 100% company-paid short-term disability coverage

• Flexible Spending Accounts (FSA): Pre-tax accounts available for healthcare and dependent care expenses

• Professional Development & Training Opportunities

• Employee Assistance & Benefits Support through Bennie

• Voluntary Benefits including supplemental life, accident, and disability insurance

__Pathways Healthcare is committed to providing exceptional care to our patients and fostering a positive work environment for our team members. If you're passionate about making a difference in people's lives and possess the required qualifications, we encourage you to apply for this exciting opportunity!__