Billing & Revenue Cycle Coordinator

BROCKTON HOME HEALTH CARE AGENCY

Billing & Revenue Cycle Coordinator

Department: Administration / Finance
Reports To: Administrator
Employment Status: Full-Time
Position Type: Administrative / Revenue Cycle Management

Brockton Home Health Care Agency is establishing the position of Billing & Revenue Cycle Coordinator to strengthen oversight of the agency’s billing, claims, authorizations, and accounts receivable processes.

The Billing & Revenue Cycle Coordinator will serve asthe primary liaison between Brockton Home Health Care Agency’s clinical department and the agency’s external billing company
.

The primary purpose of this position is to ensure and manage that services provided by the agency are properly authorized, documented,billed accurately, submitted timely, and followed through to payment.

This position is not intended to process billing. The coordinator will provide a level of internal oversight and accountability tohelp identify billing errors, authorization issues, documentation problems,missed claims, denials, and outstanding receivables before they negatively affect the agency.

Review the agency’s weekly billing activity and verify that eligible services have been submitted for billing.

Compare scheduled and completed services against claims being prepared or submitted by the billing company.

Identify services that were provided but have not yet been billed and determine the reason for the delay.

Review billing for accuracy, including patient/member information, payer, authorization, service dates, units, and applicable billing codes.

Maintain a weekly billing reconciliation process so management can clearly identify:

• Services provided
• Claims submitted
• Claim spending
• Claims held
• Claims denied or rejected
• Payments received
• Outstanding accounts receivable

Review active Prior Authorizations to ensure services being provided and billed are within the approved authorization period, service type,frequency, and units.

Track PA effective dates and expiration dates and communicate upcoming expirations to the appropriate clinical or administrative staff.

Identify services that may be at risk of nonpayment becauseof expired, missing, incorrect, or insufficient authorizations.

Work with the Clinical Manager and appropriate staff toresolve discrepancies before claims are submitted whenever possible.

Serve as the agency’s primary internal contact with the external billing company.

Participate in a weekly billing and accounts receivable meeting with the billing company.

Prepare issues requiring discussion before each meeting and maintain a follow-up list of unresolved items.

Request clarification and supporting information regarding rejected, denied, unpaid, or delayed claims.

Hold the billing company accountable for timely claim submission, correction, resubmission, and follow-up.

Escalate significant or recurring billing concerns to agency management.

Work closely with the Clinical Manager and clinical team tomake sure documentation required for billing is complete and submitted timely.

Identify claims that cannot be billed because of missing,incomplete, unsigned, or late clinical documentation.

Communicate documentation deficiencies to the appropriate department and track them until resolved.

Help ensure that the services documented in the clinical record support the services being billed.

Monitor claims to make sure they are submitted within payer timely-filing requirements.

Review rejected and denied claims to identify the cause and coordinate corrective action.

Track corrected claims, resubmissions, appeals, and other follow-up activities when…