Pre-Bill Specialist

JoinSynergy’shighperformingrevenue cycle team as aPre-BillSpecialist! We are seeking adetaildriven,compliancefocusedprofessional to ensure accuracy and completeness of all documentationbeforeclaims aresubmitted. Your commitment to precision will directly support clean claims, faster reimbursement, and the overall financial health of ourpatientcenteredservices.

About the Role

ThePre-BillSpecialistis responsible forconducting comprehensive audits of patient charts prior to claim submission. This role ensures that all required documentation, authorizations, visit notes, orders, andpayerspecificelements are complete, compliant, and correctly aligned with billing requirements. As a critical part of the revenue cycle, this position helps prevent denials,acceleratereimbursement, and safeguards regulatory compliance across Home Health and Hospice programs.

Key Responsibilities

Chart Review & Audit

• Perform detailed prebilling audits on all Home Health and Hospice charts to verify documentation completeness and accuracy.

• Confirm all visit notes, supervisory notes, plans ofcare,OASIS assessments, certifications, and recertifications are signed, dated, and compliant with payer and regulatory requirements.

• Completes an administrative record audit following patient dischargeor prior to billingand forwards abnormal results to the Clinical Director or their designee for clinical audit.

• Supervises the use of the clinical records information system andmaintainsa comprehensive working knowledge of the system including upgrades and enhancements.

Authorization & Eligibility Verification

• Validate patient eligibility, insurance coverage, and authorization requirements prior to claim release.

• Ensure authorizations are active and applicable to the dates, disciplines, and service types billed.

Compliance & Quality Assurance

• Identifymissing or noncompliant documentation and collaborate with clinical teams to resolve deficiencies prior to billing.

• Ensure all documentation adheres to federal and state regulations, Medicare/Medicaid requirements, and internal policies.

• Ensures clinical record systems aremaintainedin compliance with state,federaland regulations.

• Maintains comprehensive working knowledge of state, federal regulations and serves as a resource for appropriate organization personnel.

Coordination & Communication

• Work closely with clinical, scheduling, and billing teams to resolve documentation gaps that may delay claim submission.

• Providetimelyfeedback and clarification on documentation discrepancies to ensure efficient workflow.

• Communicates effectively, professionally, and thoroughly with staffregardingcoordination of care expectations, educates and enforces deadlines, andestablishesand maintains positive working relationships with current staff and contract staff.

Regulatory & Billing Alignment

• Maintain current knowledge ofHome Health andHospice regulatory requirements, andpayerspecificprebilling criteria.

• Verify that documentation supports the codes, service lines, frequencies, and episodes billed.

Qualifications

Required

• Minimum of 1 year of experience inHome Health or Hospice documentation review, QA, billing, or coding.

• UnderstandingMedicare, Medicaid,Government,andCommercial payer documentation requirements.

• Experience working within anEMRand familiarity with workflow queues, chart audits, and documentation compliance.

• Knowledge of corporate business management and governmental regulations

• Demonstrates good communication skills and public relations skills.

Preferred

• Prior experience conducting prebilling or QA reviews in a Home Health or Hospice setting.

• FamiliarityCMS requirements for Home Health and Hospice admissions, signedorderscompliance, regulatoryformsand criteria for compliant billing.

• Use of Home Care Home Base (HCHB) EMR, Mosai (formerly known asForcura) e-fax portal. 

Skills and Competencies

• Exceptional attention to detailand strong commitment to documentation accuracy.

• Ability toidentifycompliance issues and communicate them clearly and professionally.

• Highly organized with the ability to manage multiple charts and deadlines simultaneously.

• Strongcriticalthinkingskills to evaluate chart completeness and identify potential issues before claims are submitted.

• Collaborative and proactive approach to working with clinical and billing teams.

• Ethical andcompliancedrivenmindset.

If you take pride in accuracy, compliance, and ensuring a smooth revenue cycle, we invite you to apply for the role ofPre-BillSpecialisttoday!