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
