Infusion Center Biller/Intake Specialist

5 days ago


Artesia, California, United States Jobot Full time
Job Summary

We are seeking an experienced and detail-oriented Biller/Intake Specialist to join our team at a leading pharmacy in Southern California. This crucial role ensures seamless patient onboarding, efficient billing processes, and optimal revenue cycle management as we continue to expand our services and deliver exceptional patient care.

Responsibilities:
  • Conduct comprehensive insurance verifications, including benefits investigation for infusion therapies, and obtain and manage prior authorizations for infusion treatments.
  • Process complex infusion therapy claims using appropriate coding, manage drug wastage billing, and handle claim denials and appeals, particularly for high-cost specialty medications.
  • Liaise with specialty pharmacies for medication procurement and billing, and manage split-billing scenarios for pharmacy-dispensed medications administered in the infusion center.
  • Monitor key performance indicators (KPIs) such as clean claim rate, days in A/R, and denial rate, and implement strategies to reduce claim rejections and improve first-pass resolution rates.
  • Ensure compliance with Medicare and commercial payer guidelines for infusion billing, and maintain accurate and complete documentation to support medical necessity for infusion treatments.
  • Provide clear explanations of infusion therapy costs and insurance coverage, and assist patients in navigating manufacturer assistance programs and copay support options.
Requirements:
  • Bachelor's degree in healthcare administration, Medical Billing and Coding, or related field.
  • 3+ years of experience in medical billing, with specific experience in infusion center or specialty pharmacy billing.
  • In-depth knowledge of billing guidelines and specialty medication reimbursement.
  • Proficiency in infusion center management software and electronic health record systems.
  • Strong understanding of HCPCS Level II coding for drugs and biologicals.
  • Familiarity with USP standards and their impact on billing practices.


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