Hours: Full-time 40+ hours/week, Monday – Friday (Non-Exempt)
Location: Homesura -Minnetonka/Hybrid
Compensation: $28.75 - $33.60
The Senior Homecare Billing Specialist is responsible for preparing, daily, monthly, and quarterly review of Accounts Receivable and Revenue and Receivable analysis and for preparing, submitting, and managing billing claims to Minnesota DHS and managed care organizations to ensure accurate and timely reimbursement for homecare services. This role reviews client eligibility, verifies authorization details, submits claims, monitors payment status, and proactively follows up to resolve denials, discrepancies, or delays in processing.
The Senior Homecare Billing Specialist serves as a key liaison between internal teams, payer representatives, and state systems, ensuring all billing documentation is complete, compliant, and submitted within required timeframes. They maintain detailed records, research unpaid claims, escalate issues when necessary, and ensure billing workflows are consistently aligned with regulatory and payer-specific requirements.
Success in this role requires strong analytical skills, attention to detail, and the ability to manage a high volume of claims with accuracy and consistency. The ideal candidate is organized, deadline driven, and comfortable navigating payer portals, MNITS, and billing software systems.
This position plays a critical role in supporting organizational revenue, ensuring compliance with state and payer regulations, and maintaining uninterrupted financial operations for homecare services.
Main Duties:
Billing & Claims Processing
- Prepare, submit, and track timely and accurate electronic claims to DHS, Medicare/Medicaid managed care organizations, and commercial insurance payers.
- Ensure that claims reflect correct service codes, units, modifiers, and authorization of information specific to homecare programs.
- Verify client eligibility regularly using MN ITS and payer portals.
- Process resubmissions, voids, and adjustments as needed to correct billing discrepancies.
Authorization Management
- Review authorization details (units, dates, service types) prior to billing to prevent claim denials.
- Submit initial, concurrent, and renewal authorization requests to state agencies and MCOs.
- Monitor authorization status and follow up frequently to ensure timely approval.
- Track expiration dates and ensure renewals are submitted in advance to prevent service gaps.
- Respond to payer requests for additional information, corrections, or clarifications.
- Research and resolve issues related to missing, incorrect, or denied authorizations.
Denial Management & Follow-Up
- Research unpaid or rejected claims and take corrective actions to secure reimbursement.
- Communicate with payer representatives to resolve complex billing issues.
- Document all follow-up activities in billing systems and ensure timely escalation when payment barriers arise.
Eligibility & Compliance
- Verify client eligibility, plan type, and benefits coverage through state systems, MCO portals, or eligibility tools.
- Ensure service authorizations align with regulatory requirements, plan limits, and clinical guidelines.
- Maintain compliance with DHS, HIPAA, and payer-specific regulations for homecare billing.
- Assist in internal audits and respond to payer audit requests with accurate documentation.
Collaboration and Communication
- Required to work collaboratively with the Homesura Operations Department to ensure consistent alignment on policies and billing procedures.
- Work closely with Intake, Scheduling, and Case Management to ensure accurate billing data.
- Provide clear communication to internal staff regarding billing requirements, updates, and identified issues.
- Deliver professional and timely customer service to caregivers, clients, and external partners.
Documentation & Recordkeeping
- Daily, monthly, and quarterly review of Accounts Receivable
- Monthly reports Account Receivable analysis
- Maintain accurate and timely records of all authorization requests, approvals, denials, and renewals.
- Track reimbursement trends and notify leadership of systemic issues impacting payments.
- Assist with month-end billing reconciliation tasks as assigned.
- All other duties as assigned.