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Infusion Center Billing Specialist

1 month ago

Artesia, California, United States Jobot Full time
Our client, a leading pharmacy in Southern California, is seeking an experienced Biller/Intake Specialist for their new infusion center. 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.

**Key Responsibilities:**

* Patient Intake and Insurance Verification: Conduct comprehensive insurance verifications, obtain and manage prior authorizations for infusion treatments, and educate patients on insurance coverage and financial assistance programs.
* Billing and Claims Management: Process complex infusion therapy claims using appropriate coding, manage drug wastage billing, and handle claim denials and appeals.
* Specialty Pharmacy Coordination: Liaise with specialty pharmacies for medication procurement and billing, and manage split-billing scenarios for pharmacy-dispensed medications administered in the infusion center.
* Revenue Cycle Optimization: Monitor key performance indicators, implement strategies to reduce claim rejections, and stay updated on payer policies specific to infusion therapies and specialty medications.
* Compliance and Documentation: Ensure compliance with Medicare and commercial payer guidelines for infusion billing, and maintain accurate and complete documentation to support medical necessity for infusion treatments.

**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

**Preferred Skills:**

* Expertise in navigating complex prior authorization processes for high-cost infusion therapies
* Strong analytical skills for interpreting EOBs and resolving complex claim issues
* Excellent communication skills for interacting with patients, providers, and payers
* Ability to stay updated on rapidly changing billing regulations in the infusion therapy space