Billing Assistant/EVV Coordinator

Pittsburgh, PA

Full Time

Mid Level

IDEAL HOME HEALTH CARE, LLC

JOB DESCRIPTION

JOB TITLE: Billing Assistant / EVV Coordinator
REPORTS TO: Administrator

A. BASIC PURPOSE

The Billing Assistant / EVV Coordinator is responsible for ensuring the accuracy, compliance, and timely completion of Electronic Visit Verification (EVV), scheduling oversight, insurance eligibility verification, and billing functions. This position supports agency operations by monitoring visit documentation, maintaining payor compliance requirements, processing billing submissions, and assisting with administrative functions necessary to ensure uninterrupted patient services and revenue cycle management.

B. PRIMARY RESPONSIBILITIES

Billing Management

Scheduling Oversight

Monitor patient schedules to ensure services align with authorized hours and approved Plans of Care.
Verify that all scheduled visits are completed, documented, and appropriately billed.
Identify scheduling discrepancies and coordinate corrective actions with appropriate departments.

EVV Compliance & Dashboard Monitoring

Monitor the EVV call dashboard throughout the workday and address visit exceptions promptly.
Review EVV records daily for missed clock-ins, clock-outs, documentation issues, and visit discrepancies.
Communicate with caregivers, patients, and supervisors to resolve EVV exceptions.
Maintain a minimum quarterly EVV compliance rate of 90% or greater, or as required by payer contracts and agency standards.

Prebilling & Billing Submission

Review and clear all prebilling items within established deadlines.
Complete prebilling review and prepare billing for services rendered from the 1st through the 15th by the first business day following the 15th of each month.
Complete prebilling review and prepare billing for services rendered from the 16th through the end of the month by the first business day of the following month.
Submit accurate and timely claims through HHAeXchange, Availity, and other payer-required billing platforms.
Ensure all billing submissions comply with payer guidelines and agency requirements.

Billing Tracking & Reconciliation

Maintain billing logs and tracking reports by payer source.
Reconcile claims, remittance advice, and Explanation of Benefits (EOBs).
Research claim denials, payment discrepancies, and billing errors and initiate corrective actions or rebilling as necessary.
Assist with reporting and revenue tracking activities.

Funds Allocation

Allocate incoming payments to appropriate agency bank accounts based on remittance documentation and internal procedures.

Missed Shift Reporting

Prepare and submit all required missed shift reports accurately and within payer deadlines.
Submit UPMC and Highmark missed shift reports monthly by the 10th day of the following month.
Submit AmeriHealth and Health Partners Plan missed shift reports weekly every Tuesday.
Maintain documentation supporting all reported missed visits.

Insurance Eligibility Verification

Conduct insurance eligibility verification for all active patients every Monday or Tuesday when Monday falls on a holiday.
Perform monthly eligibility verification on the first business day of each month.
Notify appropriate staff, patients, and family members of any eligibility changes, coverage issues, or payer updates.
Maintain documentation of eligibility verification activities.

Employee System Maintenance

Enter newly hired employees into HHAeXchange, Alora, and other agency systems as assigned.
Maintain employee demographic and status information in agency software systems.
Assist with system updates and data maintenance as needed.

Administrative Support

Provide support to Billing, Scheduling, Intake, Human Resources, Nursing, and Administrative departments as assigned.
Complete special projects and additional duties within required deadlines.
Participate in process improvement initiatives to improve efficiency and compliance.

The primary responsibility statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

HUMAN RELATIONS

Must maintain a professional attitude and demeanor and communicate effectively and courteously with patients, caregivers, referral partners, supervisors, and co-workers.
Must work collaboratively with all departments to ensure timely billing, accurate documentation, and regulatory compliance.
Must demonstrate attention to detail, accountability, and commitment to quality service.

C. QUALIFICATIONS

High school diploma or equivalent required.
Associate degree in Healthcare Administration, Business Administration, Accounting, or related field preferred.
Minimum one (1) year of experience in healthcare billing, EVV coordination, scheduling, administrative support, or related healthcare operations preferred.
Working knowledge of Medicaid, Managed Care Organizations (MCOs), EVV requirements, and healthcare billing processes preferred.
Strong organizational, analytical, and problem-solving skills.
Proficiency in Microsoft Office applications, including Excel, Outlook, and Word.
Ability to manage multiple priorities and meet strict deadlines.

D. PREFERRED SKILLS

Experience with HHAeXchange, Alora Plus, Availity, NaviNet, or similar healthcare systems.
Familiarity with Pennsylvania Medicaid home care billing requirements.
Experience working with managed care organizations including UPMC, AmeriHealth, Highmark Wholecare, and Health Partners Plans.
Ability to analyze billing discrepancies and resolve claim issues independently.
Bilingual in Nepali and/or Spanish preferred.

E. OTHER REQUIREMENTS

a. Satisfactory professional references.
b. Satisfactory criminal background check and applicable clearances.
c. Ability to maintain confidentiality and comply with HIPAA requirements.
d. Ability to sit for extended periods while performing computer-based work.
e. Ability to occasionally lift office materials weighing up to 20 pounds.

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Billing Assistant/EVV Coordinator

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