Pre-Bill Specialist

Pinnacle Senior Living; Nashville (TN); On-site; USD 52,000 - 80,000; Full time

Job summary

The Pennant Group, Inc. is seeking a detail‑driven Pre‑Bill Review Specialist in Nashville to audit patient charts before claim submission. The role focuses on ensuring documentation completeness, approvals, and payer requirements to prevent denials and speed reimbursements.

You will collaborate with clinical and billing teams to resolve documentation gaps, verify eligibility, and maintain compliance with Medicare/Medicaid and applicable regulations across home health and hospice programs.

Qualifications

• Minimum of 1 year of experience in Home Health or Hospice documentation review, QA, billing, or coding.
• Understanding Medicare, Medicaid, Government, and Commercial payer documentation requirements.
• Experience working within an EMR and familiarity with workflow queues, chart audits, and documentation compliance.
• Knowledge of corporate business management and governmental regulations.
• Demonstrates good communication skills and public relations skills.

Responsibilities

• Perform detailed pre billing audits to verify documentation completeness and accuracy.
• Confirm that visit notes, orders, authorizations, and assessments are signed, dated, and compliant.
• Complete administrative record audits and forward abnormal results for clinical audit.
• Supervise the use of the clinical records information system and stay current with upgrades.
• Validate patient eligibility, insurance coverage, and pre-billing authorizations.
• Identify missing or non‑compliant documentation and resolve deficiencies prior to billing.
• Maintain compliance with state/federal regulations and payer requirements.
• Communicate effectively with staff to coordinate care expectations and deadlines.

Skills

Chart audits

Medicare/Medicaid knowledge

EMR systems

Regulatory compliance

Communication skills

Tools

Home Care Home Base (HCHB)

Mosai

Forcura e-fax

Job description

Join Synergy’s high performing revenue cycle team as a Pre‑Bill Review Specialist! We are seeking a detail driven, compliance focused professional to ensure accuracy and completeness of all documentation before claims are submitted. Your commitment to precision will directly support clean claims, faster reimbursement, and the overall financial health of our patient‑centered services.

About the Role

The Pre‑Bill Review Specialist is responsible for conducting comprehensive audits of patient charts prior to claim submission. This role ensures that all required documentation, authorizations, visit notes, orders, and payer‑specific elements are complete, compliant, and correctly aligned with billing requirements. As a critical part of the revenue cycle, this position helps prevent denials, accelerate reimbursement, and safeguards regulatory compliance across Home Health and Hospice programs.

Key Responsibilities

Chart Review & Audit

• Perform detailed pre billing audits on all Home Health and Hospice charts to verify documentation completeness and accuracy.
• Confirm all visit notes, supervisory notes, plans of care, OASIS assessments, certifications, and recertifications are signed, dated, and compliant with payer and regulatory requirements.
• Completes an administrative record audit following patient discharge or prior to billing and forwards abnormal results to the Clinical Director or their designee for clinical audit.
• Supervises the use of the clinical records information system and maintains a comprehensive working knowledge of the system including upgrades and enhancements.

Authorization & Eligibility Verification

• Validate patient eligibility, insurance coverage, and authorization requirements prior to claim release.
• Ensure authorizations are active and applicable to the dates, disciplines, and service types billed.

Compliance & Quality Assurance

• Identify missing or non‑compliant documentation and collaborate with clinical teams to resolve deficiencies prior to billing.
• Ensure all documentation adheres to federal and state regulations, Medicare/Medicaid requirements, and internal policies.
• Ensures clinical record systems are maintained in compliance with state, federal and regulations.
• Maintains comprehensive working knowledge of state, federal regulations and serves as a resource for appropriate organization personnel.

Coordination & Communication

• Work closely with clinical, scheduling, and billing teams to resolve documentation gaps that may delay claim submission.
• Provide timely feedback and clarification on documentation discrepancies to ensure efficient workflow.
• Communicates effectively, professionally, and thoroughly with staff regarding coordination of care expectations, educates and enforces deadlines, and establishes and maintains positive working relationships with current staff and contract staff.

Regulatory & Billing Alignment

• Maintain current knowledge of Home Health and Hospice regulatory requirements, and payer‑specific pre‑billing criteria.
• Verify that documentation supports the codes, service lines, frequencies, and episodes billed.

Qualifications

Required

• Minimum of 1 year of experience in Home Health or Hospice documentation review, QA, billing, or coding.
• Understanding Medicare, Medicaid, Government, and Commercial payer documentation requirements.
• Experience working within an EMR and familiarity with workflow queues, chart audits, and documentation compliance.
• Knowledge of corporate business management and governmental regulations
• Demonstrates good communication skills and public relations skills.

Preferred

• Prior experience conducting prebilling or QA reviews in a Home Health or Hospice setting.
• Familiarity CMS requirements for Home Health and Hospice admissions, signed orders compliance, regulatory forms and criteria for compliant billing.
• Use of Home Care Home Base (HCHB) EMR, Mosai (formerly known as Forcura) e-fax portal.

Skills and Competencies

• Exceptional attention to detail and strong commitment to documentation accuracy.
• Ability to identify compliance issues and communicate them clearly and professionally.
• Highly organized with the ability to manage multiple charts and deadlines simultaneously.
• Strong critical thinking skills to evaluate chart completeness and identify potential issues before claims are submitted.
• Collaborative and proactive approach to working with clinical and billing teams.
• Ethical and compliance driven mindset.

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.