Billing Specialist

JOB SUMMARY:

The Billing Specialist is responsible for the accurate and timely submission, follow-up, and resolution of medical claims. This position requires in-depth knowledge of procedural coding, ICD-10, CPT, HCPCS, CMS-1500 claim forms, electronic claims submission, payment posting, denials, and appeals.

We are seeking a Billing Specialist with previous infusion billing experience, including biologic and specialty medication billing, J-codes, and payer reimbursement requirements, to support our growing infusion services.

QUALIFICATIONS/EDUCATION:

• High School Diploma required.
• Minimum two (2) years of experience in medical billing and collections required.
• Previous infusion billing experience required.
• Experience billing biologic and specialty medications, infusion services, and J-codes required.
• Knowledge of payer reimbursement requirements for infusion medications and services preferred.
• Bilingual English/Spanish preferred; must be able to read, write, and speak English.
• Basic computer knowledge, including Microsoft Word, Excel, Internet, Electronic Health Records (EHR), practice management systems, e-faxes, and email.

CERTIFICATIONS/LICENSES:

• CPC preferred.

ABILITIES/SKILLS:

• In-depth knowledge of CPT, ICD-10, HCPCS, and medical billing regulations.
• Strong knowledge of infusion billing, biologic and specialty medications, J-code billing, and payer reimbursement requirements.
• Understanding of Medicare, Medicaid, and commercial payer billing requirements.
• Ability to review infusion claims for appropriate coding, documentation, authorization, and reimbursement requirements.
• Excellent communication, customer service, and telephone skills.
• Strong organizational skills and ability to multitask effectively.
• Ability to work independently with minimal supervision.
• Ability to respect and maintain patient confidentiality at all times.
• Dependable, professional, and detail-oriented.
• Proficiency in Electronic Health Records, billing software, Microsoft Office applications, and other applicable systems.
• Ability to follow company policies and procedures.

SUPERVISORY RESPONSIBILITIES:

• N/A

ESSENTIAL DUTIES/RESPONSIBILITIES:

• Process medical claims daily, ensuring the correct diagnosis, CPT, HCPCS, and infusion-related billing codes are utilized.
• Prepare and submit claims for infusion services, biologic medications, and specialty medications, including applicable J-codes.
• Review infusion claims for accuracy and compliance with payer-specific billing and reimbursement requirements.
• Verify that required prior authorizations and referrals are obtained and appropriately documented before claim submission.
• Review provider documentation, infusion records, and progress notes to ensure services and medications billed are supported by the medical record.
• Maintain the billing process within the established 15-day billing timeframe.
• Process between 80 and 100 claims per day while maintaining accuracy and productivity standards.
• Submit claim batches to the clearinghouse daily.
• Review and resolve claim rejections and denials, resubmitting corrected claims as appropriate.
• Follow up with insurance carriers regarding unpaid, denied, or underpaid infusion and medical claims.
• Research infusion-related denials, including issues involving authorization, medical necessity, coding, medication units, and payer reimbursement requirements.
• Analyze denial trends and identify opportunities to improve reimbursement and reduce billing errors.
• Maintain accurate and detailed account notes within the billing system.
• Prepare and submit weekly productivity reports to the Revenue Cycle Manager.
• Collaborate with providers, coding staff, authorization staff, and infusion personnel to resolve billing issues and maximize reimbursement.
• Perform other duties as assigned by management.