Senior Homecare Billing Specialist

Main Duties

• Billing & Claims Processing
• Prepare, submit, and track timely and accurate electronic claims to DHS, Medicare/Medicaid managed care organizations, and commercial insurance payers.
• Ensure that claims reflect correct service codes, units, modifiers, and authorization of information specific to homecare programs.
• Verify client eligibility regularly using MN ITS and payer portals.
• Process resubmissions, voids, and adjustments as needed to correct billing discrepancies.
• Authorization Management
• Review authorization details (units, dates, service types) prior to billing to prevent claim denials.
• Submit initial, concurrent, and renewal authorization requests to state agencies and MCOs.
• Maintain compliance with DHS, HIPAA, and payer-specific regulations for homecare billing.
• Assist in internal audits and respond to payer audit requests with accurate documentation.
• Collaboration and Communication
• Work collaboratively with the Homesura Operations Department to ensure consistent alignment on policies and billing procedures.
• Work closely with Intake, Scheduling, and Case Management to ensure accurate billing data.
• Provide clear communication to internal staff regarding billing requirements, updates, and identified issues.
• Deliver professional and timely customer service to caregivers, clients, and external partners.

Eligibility & Compliance

• Verify client eligibility, plan type, and benefits coverage through state systems, MCO portals, or eligibility tools.
• Ensure service authorizations align with regulatory requirements, plan limits, and clinical guidelines.
• Maintain compliance with DHS, HIPAA, and payer-specific regulations for homecare billing.

Denial Management & Follow-Up

• Research unpaid or rejected claims and take corrective actions to secure reimbursement.
• Communicate with payer representatives to resolve complex billing issues.
• Document all follow-up activities in billing systems and ensure timely escalation when payment barriers arise.

Documentation & Recordkeeping

• Daily, monthly, and quarterly review of Accounts Receivable.
• Monthly reports Account Receivable analysis.
• Maintain accurate and timely records of all authorization requests, approvals, denials, and renewals.
• Track reimbursement trends and notify leadership of systemic issues impacting payments.
• Aid in month-end billing reconciliation tasks as assigned.