Home Health PDN Biller

Were looking for an experienced detail-oriented Home Health PDN Biller to join our billing team in Houston this role youll own the billing and reimbursement process for Private Duty Nursing services from claim submission and payment posting through denial management while ensuring full compliance with Medicaid Medicare Managed Care Organizations (MCOs) and commercial payer requirements.

This is a great fit for someone who knows home health billing inside and out is comfortable navigating EVV (Electronic Visit Verification) systems and authorization workflows and enjoys collaborating across Clinical Scheduling Intake and Accounts Receivable teams to keep the revenue cycle running smoothly.

PDN Billing Operations

Prepare review and submit accurate claims for Private Duty Nursing services

Verify patient eligibility insurance coverage and payer information before billing

Confirm services billed are supported by physician orders nursing documentation and approved authorizations

Validate EVV records prior to claim submission

Submit electronic claims within payer deadlines and billing cycles

Revenue Cycle Management

Monitor claim status from submission through payment

Investigate and resolve claim rejections denials and payment discrepancies

Follow up on unpaid claims and initiate appeals when needed

Reconcile payments and ensure accurate payment posting

Identify billing trends and recommend corrective actions

Authorization & Compliance

Verify valid prior authorizations before billing and monitor utilization/expiration

Coordinate authorization renewals with Intake and Clinical teams

Maintain compliance with Medicaid Medicare MCO HIPAA and other regulatory requirements

Documentation & Reporting

Review nursing visit documentation for completeness and billing accuracy

Prepare daily weekly and monthly billing reports

Track KPIs including clean claim rate denial rate days in A/R and collection rate

Required

High school diploma or equivalent (Associates or Bachelors degree preferred)

23 years of Home Health or PDN billing experience

Strong knowledge of Medicaid Medicare MCO and commercial payer billing requirements

Experience with Electronic Visit Verification (EVV) systems

Proficiency in home health billing software and EMR systems

Solid understanding of revenue cycle management

Strong analytical organizational and communication skills

Proficiency in Microsoft Office Suite especially Excel

Preferred

Certified Professional Biller (CPB) certification

Experience with Texas Medicaid PDN billing

Experience with denial management and appeals

Familiarity with payer portals and electronic claims clearinghouses

Competitive executive salary

Medical insurance

Paid time off / holidays