Pre-Bill Specialist

Join

Synergy’s

• high performing
• revenue cycle team as a
• Pre- Bill

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

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 staf
f.

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

C
ommercial 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 pre

billing 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.
• If you take pride in accuracy, compliance, and ensuring a smooth revenue cycle, we invite you to apply for the role of
• Pre- Bill

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.