Home Health Care Medical Billing Specialist

2 days ago

Quezon City, National Capital Region, Philippines Pointwest Innovations Corp. Full time $60,000 - $80,000 per year
Job Summary:

We are seeking a detail-oriented Home Health Billing Specialist based in Manila to support US-based home health agencies. The ideal candidate will have hands-on experience in processing claims under Medicare, Medicaid, and commercial payers with a strong grasp of PDGM, OASIS, and HIPPS codes. This role is crucial to ensuring timely and accurate revenue cycle performance in accordance with US home health billing standards.

Key Responsibilities:

  • Review and validate clinical and administrative documentation (e.g., OASIS, Plan of Care, Face-to-Face documentation) before billing.

  • Accurately generate and submit RAPs, Final Claims, NOAs (Notice of Admission), and NOEs (Notice of Election) through Medicare DDE, clearinghouses, or EHR systems (e.g., Kinnser, WellSky, Axxess, HCHB).

  • Assign appropriate HIPPS codes and billing modifiers based on clinical inputs and assessments.

  • Track and follow up on unpaid or denied claims; initiate appeals and resubmissions as necessary.

  • Maintain AR follow-up and timely posting of payments, adjustments, and write-offs.

    Communicate proactively with US-based teams (Billing, Clinical, QA) to resolve claim issues.

  • Stay current with CMS and payer-specific updates impacting home health billing.

  • Ensure all processes comply with HIPAA and data security standards.

Qualifications:

  • Education: College graduate (with preference for medical or business-related courses).

  • Experience: Minimum 1 year experience in US home health billing.

  • Technical Skills:

    • Familiar with Medicare billing guidelines and the PDGM model.

    • Proficient in home health EMRs (e.g., WellSky, Kinnser, Axxess, HCHB).

    • Experience using DDE/FISS and/or medical billing clearinghouses.

    • Working knowledge of HIPPS codes, CPT/HCPCS, and ICD-10.

  • Soft Skills:

    • Excellent English communication skills (written and spoken).

    • High attention to detail and organizational skills.

    • Ability to work US business hours (Eastern or Central time zones).

Preferred Qualifications:

  • Prior BPO/RPO experience in US healthcare or RCM support.

  • Knowledge of U.S. insurance authorization and eligibility workflows.

  • Certification in medical billing (e.g., AAPC CPB, AMBA CMRS) is a plus.

Work Setup:

  • Schedule: Mixed; Day Shift & Night shift aligned with US time zones (EST/CST preferred).

  • Work Location: 100% Work-in-Office

    Tools Provided: HIPAA-compliant equipment and secure internet access required

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