Reimbursement Specialist (Home Health exp. Preferred)

Addus HomeCare, Inc.; Frisco, Northern (TX, KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental and Vision Benefits

Continued Education

PTO Plan

Retirement Planning

Life Insurance

Employee discounts

Job summary

Addus Homecare, Inc. in Frisco, TX is seeking a Reimbursement Specialist (Home Health) to manage billing and revenue cycle activities, including insurance benefit verification, claim submissions, and authorization requests for a variety of payers.

The ideal candidate will have experience with Home Health, EVV, and Private Duty, strong communication skills, and the ability to navigate Medicare/Medicaid guidelines while maintaining confidentiality and high service standards.

Qualifications

• Strong understanding of hospice billing regulations (Medicare, Medicaid, commercial)
• Effective payer follow-up and escalation strategies
• Ability to read and interpret EOBs, remittances, and denial codes
• Represents the organization professionally at all times

Responsibilities

• Accurately interprets patient insurance, prescription and other health-related documentation
• Conducts medical insurance verifications and investigations for commercial and government payors
• Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
• Reviews unpaid accounts to determine status and taking appropriate action to ensure payment.
• Reviews all claims for compliance and completeness for claims submissions.
• Researches available alternative funding options to reduce patient’s financial burden
• Handles high call volumes
• Maintains a high degree of confidentiality at all times due to access to sensitive information

Skills

Communication skills

Customer service

Attention to detail

Data entry

MS Office

Education

High school diploma or equivalent

Job description

Position Summary

The Reimbursement Specialist (Home Health) will be responsible for billing and revenue cycle management thorough insurance benefit investigation of new referrals, assignment of collections with a variety of payers, authorization requests, and claim submissions. We would like to hire someone familiar with Home Health especially EVV as well as Private Duty experience.

Schedule

Monday-Friday 8am to 5pm Central Standard Time (Remote)

• Medical, Dental and Vision Benefits
• Continued Education
• PTO Plan
• Retirement Planning
• Life Insurance
• Employee discounts

Essential Duties:

• Accurately interprets patient insurance, prescription and other health-related documentation
• Conducts medical insurance verifications and investigations for commercial and government payors
• Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
• Reviews unpaid accounts to determine status and taking appropriate action to ensure payment.
• Reviews all claims for compliance and completeness for claims submissions.
• Researches available alternative funding options to reduce patient’s financial burden
• Handles high call volumes
• Communicates with internal and external departments to facilitate coordination of care
• Maintains a high degree of confidentiality at all times due to access to sensitive information
• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
• Follows all Medicare, Medicaid, and HIPAA regulations and requirements
• Abides by all regulations, policies, procedures and standards
• Performs other duties as assigned

Position Requirements & Competencies:

• High school diploma or equivalent is required; Undergraduate degree is preferred
• 5 years of healthcare collections/billing experience preferred
• Strong understanding of hospice billing regulations (Medicare, Medicaid, commercial
• Ability to read and interpret EOBs, remittances, and denial codes
• Effective payer follow-up and escalation strategies
• Ability to resolve claim holds, rejections, and denial
• Ability to identify trends in denials or delay
• Root-cause analysis to prevent recurring issues
• High attention to detail to ensure clean claims
• Ability to work AR reports and aging summaries accurately
• Clear, professional communication with internal teams and payer reps
• Ability to explain payer issues in plain, understandable language
• Possess quick and accurate Alpha/numeric data entry skills
• Computer proficiency – MS Office and Web-enabled applications strongly preferred
• Customer service skills required.
• Maintains positive internal and external customer service relationships
• Plans and organizes work effectively and ensures its completion
• Meets all productivity requirements
• Demonstrates team behavior and promotes a team-oriented environment
• Actively participates in Continuous Quality Improvement
• Represents the organization professionally at all times
• Self-starter with exceptional organizational and follow-through skills
• Ability to work independently and in a team environment

Employee wellbeing is top priority at Addus Homecare, and we're thrilled to announce our recognition as the top healthcare company on Indeed's 2024 Top 100 Work Wellbeing Index. View the full rankings here: https://www.indeed.com/employers/work-wellbeing/work-wellbeing-100-ranking.