Cantex
Revenue Compliance Analyst - Home Health and Hospice (19391)
Cantex, Carrollton, Texas, us, 75011
Overview
Revenue Compliance Analyst - Home Health and Hospice (19391) role based in Dallas, TX with travel to Houston, San Antonio, and East Texas. This position supports the Revenue Compliance and Reimbursement teams, ensuring accurate documentation, coding, and billing practices for Home Health and Hospice services, and ensures adherence to federal and state regulations including CMS, OIG, and Local Coverage Determinations. The analyst acts as a liaison between payers, providers, and billing teams with a primary focus on Home Health and Hospice settings. Responsibilities
Auditing & Monitoring: Perform targeted and periodic audits in Home Health and Hospice agencies with high error rates or financial risk. Ensure clinical documentation supports medical necessity, level of care, and accuracy of coding (ICD-10, CPT, HHRG, HIPPS, etc.). Confirm Home Health documentation meets Face-to-Face Encounter requirements, OASIS data accuracy, and Plan of Care (POC) compliance. Validate Hospice documentation for accurate certification of terminal illness, appropriate documentation of decline and prognosis, and correct election and level of care per Medicare guidelines and LCDs. Review claim submissions, denials, and appeals to identify trends and recommend corrective actions; provide detailed feedback post-audit and support ongoing documentation improvement. Appeals & Documentation Review: Complete and review Additional Documentation Requests (ADRs), Appeals, Quality of Care (QOC) reviews, and Risk Analyses (RA) from Medicare and Managed Care Payers. Draft Medical Necessity summaries and ensure timely and accurate submission of Home Health RAPs and Final Claims, Hospice NOEs, NOTRs, and Final Claims. Monitor and track outcomes of all appeal and audit activity. Coordinate and respond to government and payer probes; assist with education and corrective action planning. Education & Communication: Collaborate with the Compliance Department to conduct internal audits and identify areas for improvement. Assist in training clinical and billing teams on compliance standards, PDGM, and Medicare Hospice Benefit requirements. Maintain open, professional communication with internal staff, leadership, payers, and regulatory bodies. Deliver feedback, reports, and recommendations to the Revenue Compliance Manager and executive leadership. Process & Reporting: Maintain accurate records of all audits and appeal activity. Submit reports regularly to the Revenue Compliance Manager, VP of Home Care-Based Services, and other leadership as needed. Conduct in-depth regulatory research related to payment policy, CMS updates, and payer requirements. Qualifications
Licensure: RN, LVN, OTR, PT, or SLP Experience: Minimum 5 years of clinical experience in post-acute care, including Home Health and Hospice. Experience with PDGM, OASIS, Hospice Conditions of Participation, Medicare documentation and billing. Coding certification required (e.g., CRC, CCS, CPC, HCS-D, HCS-H). Education: Bachelor’s, Master’s, or Doctorate in a healthcare or clinical field preferred (or equivalent experience). Knowledge: Strong understanding of CMS Conditions of Participation for SNF, Home Health, and Hospice. Proficient with Medicare billing, compliance requirements, and denial management. Preferred Continuing Education & Training: RAC-CT Certification via AANAC; ICD-10 Coding Boot Camps; PDGM and Hospice regulatory training courses; Medicare and RAC Audit Seminars; CMS Open Forums on Denials, Appeals, and Documentation Standards. Equal opportunity employer statement:
We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance plans as well as a highly competitive compensation package. Diversity, Equity and Inclusion are at the heart of Pivot Rehab. We are committed to a culture that respects our differences and values the contribution of all people. Notes
Seniority level: Mid-Senior level Employment type: Full-time Job function: Legal Industries: Hospitals and Health Care
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Revenue Compliance Analyst - Home Health and Hospice (19391) role based in Dallas, TX with travel to Houston, San Antonio, and East Texas. This position supports the Revenue Compliance and Reimbursement teams, ensuring accurate documentation, coding, and billing practices for Home Health and Hospice services, and ensures adherence to federal and state regulations including CMS, OIG, and Local Coverage Determinations. The analyst acts as a liaison between payers, providers, and billing teams with a primary focus on Home Health and Hospice settings. Responsibilities
Auditing & Monitoring: Perform targeted and periodic audits in Home Health and Hospice agencies with high error rates or financial risk. Ensure clinical documentation supports medical necessity, level of care, and accuracy of coding (ICD-10, CPT, HHRG, HIPPS, etc.). Confirm Home Health documentation meets Face-to-Face Encounter requirements, OASIS data accuracy, and Plan of Care (POC) compliance. Validate Hospice documentation for accurate certification of terminal illness, appropriate documentation of decline and prognosis, and correct election and level of care per Medicare guidelines and LCDs. Review claim submissions, denials, and appeals to identify trends and recommend corrective actions; provide detailed feedback post-audit and support ongoing documentation improvement. Appeals & Documentation Review: Complete and review Additional Documentation Requests (ADRs), Appeals, Quality of Care (QOC) reviews, and Risk Analyses (RA) from Medicare and Managed Care Payers. Draft Medical Necessity summaries and ensure timely and accurate submission of Home Health RAPs and Final Claims, Hospice NOEs, NOTRs, and Final Claims. Monitor and track outcomes of all appeal and audit activity. Coordinate and respond to government and payer probes; assist with education and corrective action planning. Education & Communication: Collaborate with the Compliance Department to conduct internal audits and identify areas for improvement. Assist in training clinical and billing teams on compliance standards, PDGM, and Medicare Hospice Benefit requirements. Maintain open, professional communication with internal staff, leadership, payers, and regulatory bodies. Deliver feedback, reports, and recommendations to the Revenue Compliance Manager and executive leadership. Process & Reporting: Maintain accurate records of all audits and appeal activity. Submit reports regularly to the Revenue Compliance Manager, VP of Home Care-Based Services, and other leadership as needed. Conduct in-depth regulatory research related to payment policy, CMS updates, and payer requirements. Qualifications
Licensure: RN, LVN, OTR, PT, or SLP Experience: Minimum 5 years of clinical experience in post-acute care, including Home Health and Hospice. Experience with PDGM, OASIS, Hospice Conditions of Participation, Medicare documentation and billing. Coding certification required (e.g., CRC, CCS, CPC, HCS-D, HCS-H). Education: Bachelor’s, Master’s, or Doctorate in a healthcare or clinical field preferred (or equivalent experience). Knowledge: Strong understanding of CMS Conditions of Participation for SNF, Home Health, and Hospice. Proficient with Medicare billing, compliance requirements, and denial management. Preferred Continuing Education & Training: RAC-CT Certification via AANAC; ICD-10 Coding Boot Camps; PDGM and Hospice regulatory training courses; Medicare and RAC Audit Seminars; CMS Open Forums on Denials, Appeals, and Documentation Standards. Equal opportunity employer statement:
We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance plans as well as a highly competitive compensation package. Diversity, Equity and Inclusion are at the heart of Pivot Rehab. We are committed to a culture that respects our differences and values the contribution of all people. Notes
Seniority level: Mid-Senior level Employment type: Full-time Job function: Legal Industries: Hospitals and Health Care
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