US Medical Billing Specialist

High school diploma or equivalent (required). Associate's or bachelor’s degree in a related field (preferred). Certification in medical billing and coding (e.g., CPC, CHBME) is highly desirable. 1-3 years of experience in medical billing, preferably in a home health care setting. Strong knowledge of home health billing codes, insurance guidelines, and reimbursement processes. Proficiency with electronic health records (EHR) and billing software. Attention to detail and accuracy in data entry and documentation. Excellent problem-solving and organizational skills. Strong written and verbal communication skills. Familiarity with Medicare and Medicaid billing guidelines specific to home health. Experience with claim submission platforms such as Medicare DDE and clearinghouses. Knowledge of HIPAA regulations.

Prepare, review, and submit accurate claims to insurance companies. Verify and ensure accuracy of billing codes (CPT, HCPCS, ICD-10) and modifiers. Maintain knowledge of Medicare, Medicaid, and private insurance billing requirements for home health care. Use billing software to process and track claims. Monitor claim status and follow up on unpaid or denied claims. Investigate and resolve claim discrepancies, denials, and appeals. Generate reports for outstanding accounts receivable. Ensure all billing practices comply with federal, state, and local regulations. Verify patient insurance information, eligibility, and prior authorization requirements. Maintain accurate records of billing activities. Collaborate with office staff and payers to address billing and reimbursement issues. Provide clear communication to patients regarding their billing and financial responsibilities. Respond to inquiries from payers, patients, and colleagues.