A home health billing specialist collects what Medicare, Medicare Advantage and Medicaid plans, long-term care insurers and families owe for the agency's visits. They send claims, work denials and records requests, track authorizations, and chase the signatures and visit notes that hold claims back.
By the HireBus team · Updated · Pay data: BLS, May 2025
Median pay, home health care agencies · BLS, May 2025
We're hiring a Billing Specialist to get us paid for the visits our team makes. You'll bill Medicare, Medicare Advantage, Medicaid, and private-pay clients, track authorizations, work denials, and chase the missing signatures and visit records that hold claims up. In home care, payroll depends on clean claims going out on time.
2. Essential Duties and Responsibilities
Submit Medicare home health Notices of Admission and final claims, and claims to Medicare Advantage, Medicaid, and commercial payers.
Bill private-pay clients and long-term care insurers, and send the care notes insurers ask for.
Track authorizations so visits don't go past the authorized number or dates.
Work denials and rejections: fix the claim, then resubmit or appeal.
Match EVV visit data to claims where your state or payer requires it.
Respond to additional documentation requests (ADRs) and payer audits with complete records.
Post payments and adjustments, and work aged accounts receivable.
3. Key Tasks / Daily Activities
Run the billing hold report and chase unsigned orders, missing visit notes, and EVV gaps.
Submit claims through [your clearinghouse] and fix rejections.
Post payments from remittances.
Call payers about unpaid or denied claims.
Warn the Intake Coordinator and Scheduler about authorizations close to running out.
4. Key Performance Indicators (KPIs)
Clean claim rate: [your target].
Denials as a share of claims: [your target].
Days sales outstanding by payer: [your target].
Unbilled visits past your billing deadline: [your target].
Notices of Admission filed on time: [your target].
5. Required Qualifications and Skills
High school diploma or equivalent; billing or coding coursework is a plus.
[2+] years of medical billing, ideally in home health, hospice, or home care.
Knows Medicare, Medicare Advantage, and Medicaid billing rules, and how to read a remittance.
Comfortable with billing software, clearinghouses, and spreadsheets.
Handles patient and billing information under HIPAA.
6. Preferred Experience
Experience with home health claims under PDGM.
Experience with Medicaid waiver billing and state EVV aggregators.
A billing or coding credential such as [CPB, CPC, or HCS-D].
Has used [your EMR or billing software].
7. Physical Requirements
Sitting at a computer for most of the day.
Occasionally lifting boxes of records up to [15] pounds.
With or without reasonable accommodation.
8. Work Environment and Schedule
Office-based in [office city]; remote or hybrid work after training: [your policy].
Regular hours: [Monday through Friday], with deadlines around payroll and claim cutoffs.
Long stretches on the phone with payers, often on hold.
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new billing specialist gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
Every medical biller sends claims and works denials. A home health biller also bills for work other companies do, and works to Medicare's clocks on records requests and money owed back.
A records request runs on a 45-day clock
When a Medicare contractor sends an additional documentation request (ADR), CMS's manual gives the agency 45 calendar days to send the records. For a program integrity contractor (UPIC), it's 30 days. Miss the deadline and the claim is denied. The billing specialist logs each ADR the day it arrives, pulls the full record, from orders and the plan of care to visit notes, and sends it complete the first time. Source: CMS Medicare Program Integrity Manual, chapter 3.
Medicare pays you for other people's work
While a patient is under your plan of care, Medicare pays your agency for all of their home health services: nursing, aide visits, therapy, social work and medical supplies. That holds even when another company provides them under an arrangement with you. Medicare rejects those services if someone else bills them. Durable medical equipment is the exception. So contract therapists and supply vendors bill the agency, and the billing specialist checks their invoices against the visits. Source: CMS Medicare Claims Processing Manual, chapter 10: Home health agency billing.
Money Medicare overpaid has a return deadline
Say the agency finds Medicare paid for a visit that never happened, or paid a claim twice. Federal rules generally allow 60 days from when the overpayment is identified to report it and send it back. If the agency is still looking, in good faith and without delay, for related overpayments, the deadline pauses until that search ends or 180 days after the first one was found, whichever comes first. The billing specialist tells the CFO the day one turns up. Source: 42 CFR 401.305: Requirements for reporting and returning of overpayments (Cornell LII).
A Medicare Advantage approval protects the claim
Medicare Advantage plans may require approval before home health visits start. Federal rules say that once a plan approves care through prior authorization, it can't later deny coverage for lack of medical necessity. It can reopen that approval only for good cause or for fraud or similar fault. So the approval, its dates and its visit count belong in the billing file. Visits past what was approved usually need a new approval. Source: 42 CFR 422.138: Prior authorization (Cornell LII).
Billing a patient takes a notice first
To pass the cost of care Medicare may not cover on to a patient, the agency gives an Advance Beneficiary Notice (ABN) before that care. One example is a patient who wants more therapy visits than are medically needed. CMS says an ABN can't be used to cover a billing rule the agency missed, such as a missing face-to-face encounter. So before a Medicare patient is billed for visits Medicare won't pay, the billing specialist checks that a signed ABN was given in time. Source: CMS Medicare Claims Processing Manual, chapter 30: Financial liability protections.
How much home health billing specialists make
The closest BLS group for home health billing specialists is billing and posting clerks. Billing and posting clerks who work for home health care agencies earned a median of $22.89 an hour ($47,610 a year) in May 2025, according to the Bureau of Labor Statistics. That’s about the same as the $48,500 median for billing and posting clerks in all industries. About 6,620 of the 404,060 billing and posting clerks in that survey work for home health care agencies.
Hourly in most agencies, salaried for some senior billers. If you add a bonus for clearing old claims, tie it to accuracy as well as speed, so nobody is rewarded for rushing a claim out.
Home health care agencies
$47,610$47,610 median Middle half $44,120–$55,320 10th–90th $38,430–$62,960
All industries
$48,500$48,500 median Middle half $42,840–$58,290 10th–90th $37,290–$67,710
$30k$40k$50k$60k$70k$80k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
Home health care agencies
$38,430
$44,120
$47,610
$55,320
$62,960
All industries
$37,290
$42,840
$48,500
$58,290
$67,710
Skills to hire for, and what you can teach
Hire for these
Reads a Medicare remittance and can tell a rejection from a denial or an adjustment
Has billed Medicare, Medicare Advantage or Medicaid claims, ideally for home health, hospice or home care
Works a long hold list in order and logs every payer call with its reference number
Asks nurses and therapists for missing notes and signatures without starting a fight
Spots a pattern in denials and can say where in the process it starts
Keeps patient information private on screen, on paper and on the phone
Teach these on the job
Your EMR's billing module and its claim edits
Your clearinghouse's rejection codes and work queues
Your state's Medicaid waiver and managed care billing rules, including EVV
The claim steps and care notes your clients' long-term care insurers ask for
Your private-pay invoicing and collections policy
Medicare claims leave the EMR's billing screens, in systems such as Axxess, WellSky or Homecare Homebase, pass through a clearinghouse, and are tracked in the Medicare contractor's provider portal. Medicaid claims may also have to match the state's EVV aggregator. In the interview, have candidates explain how they would clear a claim stuck on the billing hold report, from the first missing item to the payment.
Home health billing specialist interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
Each KPI in the template has a blank for your target. Run the reports for one quarter by payer before you fill them in, because Medicare, Medicaid plans and insurers behave differently.
Clean claim rate
Run the clearinghouse acceptance report beside the month's remittances. Count a claim as clean only if it passed every edit and paid with no fix or resubmission, then report the result for each payer.
Denials as a share of claims
Denied claims divided by claims processed, each month by payer. Tag every denial with its reason, such as authorization, eligibility, documentation or timely filing, and bring the top reasons to intake and the clinical team.
Days sales outstanding by payer
Take each payer's open balance at month-end and divide it by that payer's average daily revenue over recent months. Check the aging report beside it, since a few large stuck claims can move the result.
Unbilled visits past your billing deadline
Visits made but not billed by the cutoff you set, from the EMR's billing hold report. Sort them by hold reason, such as an unsigned order, a missing note or an EVV gap, and send each list to whoever can clear it.
Notices of Admission filed on time
New Medicare admissions whose Notice of Admission was accepted inside the deadline, divided by all new Medicare admissions, checked weekly. Review each late one with intake to find where the start-of-care date got stuck.
Career path
Billing clerk or patient accounts repPosts payments and learns remittances and payer calls.
Billing SpecialistOwns claims, denials and authorizations for a set of payers.
Billing lead or revenue cycle managerRuns the billing team and reports cash and denials to the CFO.
Compliance or claims auditorAudits claims and records against Medicare rules, in-house or for a consulting firm.
How long does an agency have to send a Medicare claim?
Medicare's limit is one calendar year from the date of service, for services since 2010. The exceptions are narrow, such as a delay caused by a Medicare contractor's own error. Home health claims often wait on signed orders and visit notes, so a claim left on hold too long can run out of time. Track holds by age as well as by count.
How much does a home health billing specialist make?
Billing and posting clerks who work for home health care agencies earned a median of $22.89 an hour ($47,610 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $44,120 and $55,320 a year. Pay also depends on your local market, experience and overtime.
Is a claim rejection the same as a denial?
No. A rejection means the claim failed an edit at the clearinghouse or the payer's front door and was never processed. Fix the error and send it again. A denial means the payer processed the claim and refused all or part of it. That calls for a corrected claim where the payer allows one, or an appeal. For Medicare, the first appeal level has a 120-day filing limit.
Should the billing specialist also code diagnoses?
Often not. Medicare places each home health period in a clinical group based on the principal diagnosis on the claim, and other diagnoses can raise the payment. That makes diagnosis coding a job of its own, and many agencies give it to a trained coder or an outside coding service. The biller still needs to know enough to spot a claim a coding edit will stop.
Can a home health billing specialist work remotely?
Yes, after training, for most of the job. Billing is screens and payer calls, so it moves home well once the specialist knows your payers and EMR. Set the rules first: an agency laptop, no paper records at home, a private place for payer calls, and access that ends the day someone leaves. Put them in your privacy and security policies so every remote worker follows the same ones.
