About this role
The Connecticut Hospice Hospital is seeking an experienced and detail-oriented Medicare Billing & Claims Submission Specialist to join our healthcare team in Branford, Connecticut.
The ideal candidate will have extensive knowledge of Medicare billing guidelines, claims processing, hospice and healthcare reimbursement methodologies, commercial insurance payer requirements, and payment posting procedures.
This position requires strong analytical skills, accuracy, and the ability to ensure timely claim submission and reimbursement.
GUIDING PRINCIPLES
- We provide quality, compassionate, and competent care.
- We support families with their decision-making.
- We support families with participation in caring for their loved ones.
- We aid in enhancing the quality of life for all our patients, for as long as their life lasts
ESSENTIAL DUTIES AND RESPONSIBILITIES
Key Responsibilities
Prepare, review, and submit Medicare, Medicaid, and commercial insurance claims accurately and timely.
Ensure compliance with CMS regulations, Medicare Claims Processing Manual guidelines, and payer-specific billing requirements.
Manage claim submissions, corrections, resubmissions, and appeals for denied or rejected claims.
Verify patient insurance eligibility and benefits.
Process Notices of Election (NOE), Notices of Termination/Revocation (NOTR), and other Medicare-related transactions as applicable.
Monitor and resolve billing issues, claim edits, and reimbursement discrepancies.
Post insurance payments, patient payments, adjustments, and contractual allowances accurately.
Reconcile accounts receivable balances and follow up on unpaid claims.
Research and resolve claim denials by communicating with payers, providers, and patients.
Maintain accurate billing, payment, and patient account records.
Stay current on Medicare regulations, reimbursement methodologies, and commercial payer policy updates.
Collaborate with clinical, administrative, and finance teams to support revenue cycle operations.
Generate billing and accounts receivable reports as needed.
This document does not create an employment contract, implied or otherwise, other than an at will relationship.
The above noted job description is not intended to describe, in detail, the variety of tasks that may be assigned but rather to give the incumbent a general sense of the responsibilities and expectations of his/her position. As the nature of business demands change, so, too, may the essential functions of this position.
Qualifications
EDUCATIONAL REQUIREMENTS, QUALIFICATIONS, & TRAININGS
Minimum 2-3 years of medical billing and claims processing experience.
Strong working knowledge of Medicare billing regulations and CMS guidelines.
Experience with Medicare/Medicaid and commercial insurance carriers and payer-specific billing requirements.
Proficiency in charge entry, payment posting, and accounts receivable follow-up.
Experience resolving claim denials and managing appeals.
Strong knowledge of ICD-10, CPT, and HCPCS coding principles.
Familiarity with electronic medical records (EMR) and billing software systems.
Excellent data entry accuracy and attention to detail.
Strong organizational, communication, and problem-solving skills.
Preferred Qualifications
Experience in hospice, home health, skilled nursing facilities, respite, palliative, or healthcare revenue cycle management.
Coding Credentials: Perfered Certified Inpatient Coder (CIC), CCS, CPC through AAPC or inpatient-focused credentials through AHIMA.
Home Care Coding Specialist–Hospice (HCS-H) offered by the Association of Home Care Coding & Compliance (AHCC).
Billing Credentials: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or similar certification preferred.
Core Skills: Assigning ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and managing MS-DRG reimbursement rules.
Knowledge of Medicare Advantage and managed care plans.
Experience with ln patient and home health hospice claims processing and reimbursement requirements.
Skills and Competencies
Medicare Claims Processing
Commercial Insurance Billing
Claims Submission & Follow-Up
Charge Entry
Payment Posting
Accounts Receivable Management
Denial Management
Revenue Cycle Management
Regulatory Compliance
Data Analysis and Reporting
Benefits
Competitive salary based on experience
Paid time off and holidays
Health, dental, and vision insurance
Retirement savings plan
Professional development opportunities
PHYSICAL REQUIREMENTS & WORK ENVIRONMENT
- Must be able to sit at a desk and work at a computer for extended periods of time.
- Requires frequent telephone use.
The qualifications, physical demands, and work environment described herein are representative of those an employee will encounter and must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities.