Job Description

Infusion For Health is dedicated to providing exceptional infusion therapy experiences for patients with autoimmune disorders and complex chronic conditions. Our mission emphasizes compassionate, patient-centered care delivered in a collaborative and professional environment.

Overview

We are seeking a detail-oriented and energetic Infusion Billing Specialist to join our administrative team. The ideal candidate will possess strong expertise in medical billing, coding, and revenue cycle management, with a focus on infusion therapy services. This role involves managing insurance claims, ensuring accurate billing practices, and supporting the financial health of our practice through precise coding and documentation.

Responsibilities

• Review infusion charges, billing records, orders, authorizations, and supporting documentation for completeness and accuracy prior to claim submission.
• Prepare and submit clean claims to Medicare, Medicaid, and commercial payers within established billing timelines.
• Accurately bill home infusion medications, supplies, administration services, and applicable per diem or related services based on payer requirements.
• Apply appropriate HCPCS/CPT codes, units, modifiers, NDC information, place of service, and other claim elements when required.
• Validate drug quantities, dosage units, dates of service, and billing units against the available billing documentation.
• Identify missing or inconsistent information that may result in claim rejection or denial and coordinate corrections before submission.

Payer Requirements & Authorization

• Review payer-specific billing guidelines, fee schedules, coverage requirements, and claim submission rules applicable to home infusion services.
• Validate that required authorizations, referrals, and other payer requirements are documented and applicable to the billed service.
• Confirm payer, member, provider, and service information is accurate and consistent with the claim and billing system.
• Identify payer-specific requirements related to modifiers, drug billing, units, waste, administration, per diem services, and supporting documentation.
• Escalate unresolved authorization or payer-related issues to the appropriate department to prevent avoidable billing delays.

Denials, Rejections & Billing Follow-Up

• Review claim rejections and denials related to billing accuracy, coding, authorization, eligibility, payer requirements, and documentation.
• Correct billing errors and resubmit claims promptly when appropriate.
• Research payer responses and denial codes to determine the appropriate corrective action.
• Communicate recurring denial trends and billing issues to the Billing Lead for review and process improvement.
• Maintain accurate billing notes and documentation of actions taken on claims.

Quality & Compliance

• Perform billing quality checks to ensure claims are accurate, complete, and supported by the available documentation.
• Follow established billing SOPs, payer requirements, and Revenue Cycle policies.
• Protect patient information and maintain confidentiality in accordance with organizational policies and applicable privacy requirements.
• Participate in internal billing audits and corrective action initiatives as assigned.
• Meet established productivity, accuracy, and timeliness expectations while maintaining a high level of attention to detail.

Team Collaboration

• Collaborate with Billing, Accounts Receivable, Authorization, Pharmacy, Operations, and other departments to resolve claim issues.
• Communicate billing concerns clearly and professionally and provide timely follow-up on outstanding items.
• Assist with identifying opportunities to improve billing workflows, reduce recurring errors, and increase clean claim rates.
• Participate in training and process updates related to home infusion billing and payer requirements.
• Prepare and submit clean claims to Medicare, Medicaid, and commercial payers within established billing timelines.
• Accurately bill infusion medications, administration services, and applicable per diem or related services based on payer requirements.
• Apply appropriate HCPCS/CPT codes, units, modifiers, NDC information, place of service, and other claim elements when required.
• Validate drug quantities, dosage units, dates of service, and billing units against the available billing documentation.
• Identify missing or inconsistent information that may result in claim rejection or denial and coordinate corrections before submission.

Qualifications

Education & Experience

• High school diploma or equivalent required; additional healthcare or business education preferred.
• Minimum 2 years of infusion billing experience required
• Experience billing Medicare, Medicaid, and commercial insurance plans required.
• Previous experience using Waystar for infusion billing required.
• Experience with HCPCS/CPT coding, claim submission, payer guidelines, and denial resolution required.