BILLING MANAGER FOR HOME HEALTH

BROCKTON HOME HEALTH CARE AGENCY

BILLING MANAGER

Department: Administration
Position: Billing Manager
Employment Status: Full-Time
Reports To: Administrator
Location: Brockton, Massachusetts

POSITION SUMMARY

Brockton Home Health Care Agency is seeking an experiencedand detail-oriented Billing Manager to manage the agency's day-to-daybilling and claims activities.

The Billing Manager is responsible for preparing, reviewing,and submitting accurate claims to Medicare, MassHealth/Medicaid, managed careorganizations, and other contracted payers. This position will also researchrejected and denied claims, correct billing errors, submit corrected claims andappeals when appropriate, monitor outstanding accounts receivable, and followclaims through final resolution.

The primary goal of this position is to ensure that allproperly authorized and documented services are billed accurately and on time,and that every unpaid, rejected, or denied claim receives appropriatefollow-up.

ESSENTIAL RESPONSIBILITIES

1. Claims Preparation & Submission

• Prepare and submit claims accurately and within required payer deadlines.
• Review claims before submission for completeness and accuracy.
• Verify patient/member demographics, insurance information, dates of service, authorization, units, service codes, modifiers, and other required billing information.
• Submit electronic and manual claims as required by individual payers.
• Ensure claims are accepted by the payer or clearinghouse after submission.
• Correct rejected claims promptly and resubmit them.
• Prevent duplicate or inappropriate billing.
• Maintain documentation of claim submission and correction activity.

2. Denial & Rejection Management

The Billing Manager will take ownership of denied andrejected claims from identification through resolution.

Responsibilities include:

• Review rejected and denied claims regularly.
• Research the specific reason for each denial.
• Determine whether the issue relates to authorization, eligibility, coding, documentation, timely filing, payer processing, or another cause.
• Correct billing errors and resubmit claims promptly.
• Prepare reconsiderations or appeals when appropriate.
• Contact insurance companies and payer representatives when additional research is necessary.
• Track denials until payment or final resolution.
• Maintain a denial log showing the claim, dollar amount, payer, denial reason, corrective action, responsible party, and status.
• Identify recurring denial patterns and report them to management.
• Recommend corrective actions to prevent repeated denials.

3. Prior Authorization Review

Before billing, verify that services requiring authorizationhave a valid PA covering the:

• Correct member
• Service type
• Dates of service
• Authorized units/hours/visits
• Frequency
• Applicable billing code

Immediately report missing, expired, insufficient, orincorrect authorizations to the appropriate department.

Do not knowingly submit claims for services that do not meetapplicable authorization requirements without appropriate management review.

4. Eligibility & Insurance Verification

Verify insurance eligibility and payer information asrequired before claim submission.

Identify changes in coverage, terminated eligibility,secondary insurance, payer changes, or other issues that may affect billing.

Communicate eligibility problems promptly so they can beresolved before they result in unnecessary denials.

5. Clinical Documentation & Billing Coordination

Work closely with the Clinical Manager and clinical staff toensure required documentation is available to support billing.

Identify services that cannot be billed because of:

• Missing visit notes
• Incomplete documentation
• Missing signatures
• Documentation submitted late
• Authorization discrepancies
• Plan-of-care issues
• Other billing-related documentation deficiencies

Track held claims until the issue has been corrected.

The Billing Manager must never create, alter, backdate, orimproperly modify clinical documentation to support a claim.

6. Accounts Receivable Management

Monitor outstanding accounts receivable and follow up onunpaid claims.

Review A/R aging, including:

0-30 Days | 31-60 Days | 61-90 Days | 90+ Days

Prioritize high-dollar and aging claims.

Research why claims remain unpaid and take appropriatefollow-up action.

Document payer calls, claim status, reference numbers,corrective actions, and expected next steps.

Escalate significant or unresolved payer issues tomanagement.

7. Timely Filing Management

Maintain awareness of payer-specific claim filing and appealdeadlines.

Monitor unbilled and denied claims approaching timely-filinglimits.

Take appropriate action before deadlines whenever possible.

Immediately notify management when a claim is at risk ofbecoming uncollectible because of a filing or appeal deadline.

8. Payment & Remittance Review

Review EOBs, ERAs, remittance advice, and payercorrespondence as assigned.

Identify:

• Denials
• Partial payments
• Underpayments
• Overpayments
• Recoupments
• Adjustments
• Incorrect contractual reductions
• Claims paid incorrectly

Research discrepancies and initiate appropriate follow-up.

10. PAYER FOLLOW-UP

Communicate professionally with Medicare,MassHealth/Medicaid, managed care organizations, commercial insurers,clearinghouses, and other payers as necessary.

Maintain documentation of payer communications and referencenumbers.

Follow unresolved claims through completion rather thansimply documenting that a payer was contacted.

11. MONTHLY DENIAL ANALYSIS

Prepare a monthly denial report identifying:

• Total number and dollar amount of denials
• Denials by payer
• Primary denial reasons
• Authorization-related denials
• Eligibility-related denials
• Documentation-related denials
• Timely-filing denials
• Corrected/resubmitted claims
• Appeals submitted
• Claims recovered
• Claims still outstanding

Management should be notified when recurring problemsindicate a process, clinical, payer, or billing-system issue.

12. COMPLIANCE & BILLING INTEGRITY

Maintain billing practices consistent with applicable payerrequirements, agency policies, and federal and Massachusetts healthcare programrequirements.

The Billing Manager must never knowingly:

• Submit a claim for a service not provided.
• Submit unsupported claims.
• Falsify or alter documentation.
• Intentionally bill incorrect units or services.
• Duplicate bill.
• Change service information solely to obtain payment.
• Conceal known billing errors.

Suspected overpayments, duplicate payments, inappropriatebilling, or other significant billing discrepancies must be reported promptlyto the Administrator.

CONFIDENTIALITY

Maintain the confidentiality and security of patient/memberinformation, financial information, payer information, passwords, and agencyrecords.

Follow HIPAA requirements and Brockton Home Health CareAgency's privacy and security policies.

REQUIRED QUALIFICATIONS

• Previous healthcare billing experience required.
• Home health billing experience strongly preferred.
• Experience submitting and correcting electronic healthcare claims.
• Experience researching claim denials and rejections.
• Knowledge of accounts receivable and revenue-cycle processes.
• Knowledge of Medicare and Medicaid/MassHealth billing preferred.
• Experience with managed care billing preferred.
• Understanding of prior authorizations and insurance eligibility.
• Familiarity with EOBs, ERAs, claim status, and denial codes.
• Understanding of timely-filing requirements.
• Ability to navigate payer portals and clearinghouses.
• Strong computer and spreadsheet skills.
• Strong mathematical and reconciliation skills.
• Excellent attention to detail.
• Strong problem-solving and research skills.
• Ability to manage multiple claims and deadlines simultaneously.
• Strong written and verbal communication skills.
• Ability to work independently and maintain organized records.
• Ability to protect confidential patient and financial information.

PREFERRED EXPERIENCE

Preference may be given to candidates with experience in:

• Massachusetts home health billing
• Medicare home health billing
• MassHealth billing
• Managed care organizations
• Medicare Advantage plans
• Medicaid managed care
• Prior authorization management
• Claim appeals
• Revenue-cycle management
• A/R recovery
• Electronic clearinghouses and payer portals

PERFORMANCE EXPECTATIONS

Performance will be evaluated based on measurable factorsincluding:

• Claim submission accuracy
• Timeliness of billing
• Rejection rate
• Preventable denial rate
• Speed of rejected-claim correction
• Denial resolution
• A/R aging
• Timely-filing compliance
• Reduction of unbilled services
• Recovery of denied/unpaid claims
• Accuracy of weekly billing reports
• Follow-through on outstanding claims

KEY PRINCIPLE OF THE POSITION

The Billing Manager's responsibility does not end when aclaim is submitted.

The position is responsible for helping manage the fullbilling cycle:

Service Provided → Documentation Completed →Authorization Verified → Eligibility Verified → Claim Prepared → ClaimSubmitted → Claim Accepted → Payment Received → Payment Reconciled

When that cycle stops at any point, the Billing Manager isexpected to identify the problem, research the cause, take appropriatecorrective action, and follow the claim until resolution or managementescalation.

PRIMARY OBJECTIVE

Bill every properly documented and authorized serviceaccurately and on time, minimize preventable denials, aggressively followoutstanding claims, and protect Brockton Home Health Care Agency's revenuewhile maintaining billing integrity and compliance.

Compensation: This is a full-time, salaried positionwith an annual salary of $82,000, paid in accordance with Brockton HomeHealth Care Agency's regular payroll schedule.