Infusion and Specialty Drug Revenue Cycle Specialist (Remote)

Essential Functions

• Submit accurate claims for infusion therapies, injectable medications, and physician-administered drugs to insurance payers.
• Track claims to ensure timely processing and reimbursement.
• Identify and address claim rejections and denials promptly.

Accounts Receivable Monitoring

• Reconcile payments and outstanding balances for infusion and injectable drug claims.
• Maintain detailed records of payer communications and payment status.
• Follow up on unpaid or underpaid claims.

Insurance Verification

• Confirm insurance eligibility and coverage for infusion therapies and physician-administered drugs.
• Collaborate with pharmacy and clinical teams to obtain prior authorizations when required.

Compliance and Documentation

• Ensure claims comply with payer policies, coding standards, and regulations.
• Maintain organized and accurate documentation for audit purposes.

Process Improvement

• Identify opportunities to optimize the infusion and medical benefit drug billing process.
• Implement solutions to enhance efficiency and reduce denials.

Knowledge, Skills and Abilities

• Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements.
• Ability to communicate effectively, both orally and in writing.
• Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR).
• Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures.
• Proficiency in insurance verification, prior authorization, and AR follow-up.
• Attention to detail, organizational skills, customer service orientation, and analytical thinking.

Minimum Education

A high school diploma or equivalent is required, with a higher degree preferred.

Preferred Experience

• 2 years of experience in infusion billing, buy-and-bill processes, specialty pharmacy billing, Part B drug billing, or medical benefit drug reimbursement.
• Experience in oncology, rheumatology, or infusion center settings is highly desirable.
• 1 year familiarity with specialty pharmacy operations is a plus.