Home Care Medical Billing Specialist
Budget: $250 – $750 USD
I manage a fast-growing home care agency and need a seasoned biller who can own the full claim cycle from first submission to final payment. Daily work will flow through both AVAILITY and HHA-EXCHANGE; solid, hands-on proficiency with these two platforms is non-negotiable because every payer we use is already connected there.
You will work primarily with Horizon, Aetna, Wellpoint, and FFSNJ (Medicaid). I expect you to know the quirks of each payer—what documentation they flag, how their denial codes translate, and the quickest escalation paths—so we stay on top of aging claims.
Clear, repeatable reporting is key for me to steer the business. Every Friday I’ll need a concise dashboard-style report that shows total charges, payments, adjustments, denials, and outstanding A/R for the week. At month-end, I’ll rely on a deeper dive that highlights revenue growth trends, payer mix, top denial reasons, and an action plan for any partially paid or unpaid claims. Both reports should be exportable (Excel or Google Sheets) and visually easy to scan.
Appeals and resubmissions are part of the rhythm here. Whenever a claim is under-paid or denied, I want it appealed within the payer’s stated window, tracked in an appeals log, and followed through until the balance is cleared. You’ll have the authority to contact medical directors, attach supporting notes from our EMR, and reopen claims as needed.
Deliverables
• Weekly claims summary (Excel/Sheets + PDF snapshot)
• Monthly revenue & trend report with visuals and commentary
• Up-to-date appeals/resubmission log with status and next steps
• Clean claim files in AVAILITY and HHA-EXCHANGE with zero errors in clearinghouse scrub
Success is simple: fewer denials, faster cash, and data that tells us exactly where we stand each week. If you’re confident you can deliver that, let’s get started.
You will work primarily with Horizon, Aetna, Wellpoint, and FFSNJ (Medicaid). I expect you to know the quirks of each payer—what documentation they flag, how their denial codes translate, and the quickest escalation paths—so we stay on top of aging claims.
Clear, repeatable reporting is key for me to steer the business. Every Friday I’ll need a concise dashboard-style report that shows total charges, payments, adjustments, denials, and outstanding A/R for the week. At month-end, I’ll rely on a deeper dive that highlights revenue growth trends, payer mix, top denial reasons, and an action plan for any partially paid or unpaid claims. Both reports should be exportable (Excel or Google Sheets) and visually easy to scan.
Appeals and resubmissions are part of the rhythm here. Whenever a claim is under-paid or denied, I want it appealed within the payer’s stated window, tracked in an appeals log, and followed through until the balance is cleared. You’ll have the authority to contact medical directors, attach supporting notes from our EMR, and reopen claims as needed.
Deliverables
• Weekly claims summary (Excel/Sheets + PDF snapshot)
• Monthly revenue & trend report with visuals and commentary
• Up-to-date appeals/resubmission log with status and next steps
• Clean claim files in AVAILITY and HHA-EXCHANGE with zero errors in clearinghouse scrub
Success is simple: fewer denials, faster cash, and data that tells us exactly where we stand each week. If you’re confident you can deliver that, let’s get started.