Pathways Healthcare

Billing Specialist

• Audit patient accounts for billing accuracy, completeness, and compliance with payer requirements
• Review accounts prior to billing to identify missing documentation, authorization issues, eligibility concerns, coding discrepancies, or other billing barriers
• Review billed accounts for potential errors, payment discrepancies, denials, underpayments, or follow-up needs
• Audit billing notes, account activity, and supporting documentation to ensure appropriate follow-up has occurred
• Review remittance advice, EOBs, claim status information, payer responses, and denial reasons
• Research billing discrepancies and determine the appropriate next steps for resolution
• Identify trends in billing errors, denials, documentation gaps, or payer issues and escalate recurring concerns
• Work collaboratively with billing, prebill, intake, authorization, clinical, scheduling, and other departments to resolve account issues
• Monitor assigned work queues, reports, or account lists to ensure outstanding issues are addressed timely
• Review insurance changes and payer information for potential billing impact
• Assist with aging reviews, account reconciliation, and identification of accounts requiring correction, appeal, adjustment, or additional follow-up
• Ensure billing-related documentation and account notes are clear, complete, and accurate
• Support internal audits and revenue cycle quality-improvement initiatives
• Provide feedback and education to internal teams when recurring billing or documentation issues are identified
• Maintain knowledge of Medicare, Medicaid, Medicare Advantage, commercial payer, Home Health, Hospice, and Part B billing requirements applicable to assigned responsibilities
• Meet established productivity, accuracy, and account-resolution expectations
• Perform additional revenue cycle and billing audit duties as assigned

Compliance

• Audit and prepare home health and hospice claims for accurate, compliant, and timely billing
• Make outbound calls to resolve documentation and billing needs
• Review face-to-face documentation, unsigned orders, and visit notes
• Follow up on missing or incomplete information
• Run daily and weekly prebill reports to identify billing issues and help prevent claim denials
• Collaborate with Clinical, Marketing, and Administrative teams to remove financial barriers and support patient care
• Meet individual and team productivity goals
• Maintain confidentiality and uphold Pathways’ TRUST values

Billing Specialist

Prebill Compliance Specialist