Billing Representative (Hospice)

Symphony-Diagnostic-Services-No1,-LL; United States; On-site; USD 55,000 - 85,000; Full time

Job summary

Symphony-Diagnostic-Services-No1,-LL is seeking a Hospice Billing Specialist to process and submit hospice claims in alignment with Medicare and other payer guidelines. You will review claims, apply GW modifiers when necessary, and ensure accuracy before billing.

You will also handle denial management, document payer communications, and support revenue cycle activities across hospice and SNF billing domains. Strong knowledge of HIPAA rules and interdepartmental collaboration are essential.

Qualifications

• Experience with Medicare hospice billing rules and payer guidelines.
• Ability to interpret medical documentation for related/unrelated services.
• Proven track record in denial management and reimbursement recovery.

Responsibilities

• Process and submit hospice-related claims per Medicare/Medicaid/payer guidelines.
• Submit claims with GW modifiers for unrelated services.
• Review submissions for accuracy before billing and posting.
• Document denial resolutions and payer communications in the billing system.

Skills

Medicare hospice billing

GW modifier

Denial management

Revenue cycle

HIPAA compliance

Communication skills

Education

High School Diploma or GED

Tools

Billing software

Microsoft Excel

Outlook

Job description

• Process and submit hospice-related claims in accordance with Medicare, Medicaid, and payer billing guidelines.
• Submit claims with appropriate modifiers, including the GW modifier for services determined to be unrelated to the patient's terminal hospice diagnosis.
• Review claim submissions for accuracy and completeness prior to billing.

Denial Management and Claims Resolution

• Submit claims to the appropriate hospice payer for reimbursement when required.
• Document all denial resolution activities and payer communications within the billing system.

Related vs. Unrelated Service Determinations

• Review hospice and skilled nursing facility correspondence, medical documentation, and supporting records to determine whether services are related or unrelated to the patient's hospice diagnosis.
• Coordinate with hospice providers and clinical staff to obtain supporting documentation for determination decisions.
• Maintain documentation supporting billing and reimbursement decisions.

Skilled Nursing Facility and Client Billing

• Ensure hospice facilities that order services receive accurate and timely charges on client invoices.
• Bill charges back to skilled nursing facilities when services are determined to be the financial responsibility of the facility.
• Maintain timely turnaround of bill-back activities with proper invoice notes to support revenue cycle goals.

Documentation and Compliance

• Ensure detailed, accurate, and compliant account notes are entered into the billing system for all billing activities, claim status updates, payer communications, denials, and reimbursement actions.
• Maintain complete audit trails within billing systems to support claim processing and reimbursement validation.
• Save, organize, and retain supporting documentation, including medical records, hospice correspondence, payer notices, denial letters, and determination documentation in accordance with company policies and regulatory requirements.
• Ensure required documentation is properly attached and maintained for compliance and audit readiness.
• Review documentation for completeness and accuracy prior to claim submission, invoicing, and reimbursement processing.
• Support internal and external audits by providing requested documentation and claim history records.

Revenue Cycle Support

• Collaborate with billing leadership, hospices, facilities, payers, Sales Teams, and internal departments to improve operational efficiency and reimbursement outcomes.

Additional Responsibilities

• Foster a collaborative team environment by supporting coworkers, sharing best practices, and contributing to department goals and success.
• Perform other related duties, projects, and responsibilities as assigned by management.
• This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Responsibilities may be added, modified, or reassigned based on business needs and organizational requirements.

Qualifications

Education

• High School Diploma or GED required.

Experience

• Experience with Medicare claims processing, billing to appropriate hospice payers, denial management, and reimbursement recovery preferred.
• Experience working with skilled nursing facilities and hospice providers preferred.

Knowledge, Skills, and Abilities

• Strong knowledge of Medicare hospice billing regulations and reimbursement guidelines.
• Understanding of GW modifier requirements and hospice-related billing practices.
• Experience billing and submitting claims to the appropriate hospice payer.
• Ability to interpret medical documentation and determine related versus unrelated hospice services.
• Strong understanding of healthcare billing and revenue cycle principles.
• Knowledge of HIPAA, CMS regulations, and compliance requirements.
• Excellent analytical, organizational, and problem-solving skills.
• Excellent customer service and interpersonal skills.
• Ability to communicate professionally and effectively with external customers, internal customers, hospice providers, skilled nursing facilities, clients, and Sales Teams.
• Strong written and verbal communication skills.
• Must be a team player with the ability to collaborate effectively across departments, support team initiatives, share knowledge, and contribute to a positive work environment.
• Demonstrated ability to build and maintain productive working relationships with coworkers, leadership, Sales Teams, and business partners.
• Proficiency in billing systems, Microsoft Excel, Outlook, and other business applications.

Skills

Behaviors

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Motivations

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Education

Experience

Licenses & Certifications

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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