Billing Specialist

Job Summary

Perform duties to process Home Infusion medical claims with a focus on accuracy, timeliness, and adherence to process, to reduce denial rate, DSO, and bad debt. Performs revenue cycle billing duties to process within the limits of standard Compliance practices.

Duties/Responsibilities

• Create and submit medical, pharmacy and third-party vendor claims timely and accurately.
• Ensure all revenue opportunities are included, and complete and submit billing to primary and secondary payers.
• Resolve rejected electronic claims so that current submission is successful and future submissions are not rejected.
• Maintain ready-to-bill delivery tickets and indicate tickets that cannot be billed with appropriate status for communication purposes within RCM and Franchises.
• Document case activity, communications, and correspondence in CareTend to ensure completeness and accuracy of account activity.
• Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team.
• Perform other related duties as assigned.

Required Skills/Abilities

• Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts.
• Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
• Proven ability to identify gaps and problems from a review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
• Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
• Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
• Able to complete job duties in a designated workspace outside the dedicated RCM location.
• Disciplined work ethic with ability to work remotely with little direct supervision and meet production and collection targets.

Education and Experience

• 2-5 years home infusion billing and/or collections experience required.
• High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
• Experience in an infusion suite setting is a plus.
• Previous remote work environment is a plus but not required.
• Detailed oriented with post-billing and post-payment investigative experience preferred.

Physical Requirements

• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
• Keyboarding: Frequent use of a keyboard for typing and data entry.
• Reaching: Occasionally reaching for items such as files, documents, or office supplies.
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.