Pre-Bill Specialist

Pennant Group; Nashville (TN); On-site; USD 42,000 - 65,000; Full time

Job summary

Pennant Group is seeking a detail-driven Pre-Bill Review Specialist to audit patient charts before claims submission. You will verify documentation, authorizations, and payer requirements to prevent denials and accelerate reimbursement across Home Health and Hospice programs.

Collaborate with clinical, scheduling, and billing teams, ensuring compliance with Medicare/Medicaid and internal policies while maintaining up-to-date knowledge of regulatory requirements.

Qualifications

• 1+ year experience in Home Health or Hospice documentation review, QA, billing, or coding
• Familiarity with Medicare/Medicaid, payer documentation requirements
• Experience with EMR systems and workflow queues

Responsibilities

• Perform comprehensive pre-billing audits of Home Health and Hospice charts for completeness and accuracy
• Verify visit notes, orders, OASIS, certifications, and recertifications are signed, dated, and compliant
• Approve administrative records pre-billing and escalate abnormal results to Clinical Director
• Oversee clinical records system usage and stay updated on upgrades
• Validate patient eligibility, coverage, and authorizations before claim release
• Ensure documentation complies with federal/state regulations and internal policies
• Collaborate with clinical, scheduling, and billing teams to resolve gaps
• Provide timely feedback on documentation discrepancies to ensure efficient workflow

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 RoleThe 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 ResponsibilitiesChart Review & AuditPerform 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 VerificationValidate 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 AssuranceIdentify 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 & CommunicationWork 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 AlignmentMaintain 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.QualificationsRequiredMinimum 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 regulationsDemonstrates good communication skills and public relations skills.PreferredPrior 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 CompetenciesExceptional 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.If you take pride in accuracy, compliance, and ensuring a smooth revenue cycle, we invite you to apply for the role of Pre Bill Review Specialist today!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.