LifeCare Home Health Family

Compliance

• Support day-to-day PECOS filings, vendor regulatory documentation, and provider credentialing activities.
• Prepare and submit PECOS enrollments, revalidations, and updates under supervision.
• Collect, organize, and maintain required ownership, managing employee, and practice location documentation.
• Track CMS and MAC correspondence and assist with responses.
• Collect and maintain required regulatory documentation for vendors and contractors.
• Track expirables and ensure timely updates of required certifications and attestations.
• Assist with regulatory onboarding and offboarding documentation.
• Support credentialing activities, including license verification, certification tracking, and documentation management.
• Maintain credentialing files and ensure alignment with enrollment and payer requirements.
• Monitor expirables and notify leadership of upcoming renewals.
• Maintain regulatory trackers, calendars, and filing logs.
• Ensure records are organized, complete, and audit-ready.
• Assist with internal audits and data validation reviews.
• Coordinate with HR, Compliance, Operations, and Revenue Cycle to gather required information.

Regulatory Operations Specialist

Medical Billing and Coding

• Responsible for timely and compliant Private Duty billing, authorizations, and reimbursement for designated region
• Work directly with revenue cycle director, billing compliance coordinator, agencies, and intermediary to facilitate billing claims
• Obtain authorizations as needed
• Prepare, audit, and submit claims electronically for appropriate payment
• Follow up on outstanding claims and take appropriate action for timely payment
• Collect necessary information to prepare claims, coordinating with agencies when appropriate
• Bill and submit clean claims electronically and follow up with the Payer
• Process, collect, and manage account payments
• Monitor claims daily, report totals
• Research, correct, and re-submit rejected and denied claims
• Follow-up on corrections and report adjustments using revenue cycle management tool
• Monitor and maintain assigned accounts
• Review billing reports to maintain accurate AR balances
• Document follow-ups on claim outstanding balance until final resolution is reached
• Keep accurate and orderly records for all billing and accounts receivable activity
• Conduct pre-billing audits as assigned
• Proactive in identifying potential reimbursement issues while ensuring effective problem resolution
• Coordinate with the Agency and Billing Compliance Coordinator on relevant process issues impacting billing
• Report any billing issues that develop into trends to immediate supervisor
• Answer questions from patients, agency staff, and insurance companies
• Interpret and process Explanation of Benefits when needed
• Professionally make outbound calls while improving customer relations
• Maintain knowledge of current industry standards related to billing and cognizant of new regulations

Medical Billing Specialist, Cash Poster

• Collect all the necessary information to prepare claims, coordinating with agencies when appropriate.
• Bill and submit clean claims electronically and follow up with the Payer.
• Process, collect, and manage account payments.
• Monitor claims daily, report totals.
• Research, correct, and re-submit rejected and denied claims.
• Follow-up on corrections and report adjustments by utilizing revenue cycle management tool.
• Monitor and maintain assigned accounts.
• Review billing reports to maintain accurate AR balances.
• Document all follow-ups completed on the claim outstanding balance until the final resolution is reached.
• Keep accurate and orderly records for all billing and accounts receivable activity.
• Pre-billing audits as assigned.
• Proactive in identifying potential reimbursement issues while ensuring effective problem resolution.
• Coordinate with the Agency and Billing Compliance Coordinator on any relevant process issue impacting billing to establish a resolution.
• Report any billing issues that develop into trends to the immediate supervisor.
• Answer questions from patients, agency staff, and insurance companies.
• Interpret and process Explanation of Benefits when needed.
• Professionally make outbound calls, while keeping and improving customer relations.
• Maintain knowledge of current industry standards related to billing, cognizant of new regulations that impact billing.
• Prepare and implement any required change accordingly.

Regulatory Operations Specialist

Medical Billing Specialist, Cash Poster

PD Medical Billing Specialist, Cash Poster