Home Infusion Billing Specialist
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Job Description
Home infusion billing specialist submitting medication, supply, and administration claims. Reviewing coding, payer requirements, authorizations, denials, and reimbursement documentation.
Responsibilities:
- Review home infusion charges, billing records, orders, authorizations, and supporting documentation for completeness and accuracy
- Prepare and submit clean claims to Medicare, Medicaid, and commercial payers
- Bill home infusion medications, supplies, administration services, and applicable per diem or related services
- Apply HCPCS/CPT codes, units, modifiers, NDC information, place of service, and other claim elements
- Validate drug quantities, dosage units, dates of service, and billing units
- Identify missing or inconsistent information and coordinate corrections before submission
- Review payer-specific billing guidelines, fee schedules, coverage requirements, and claim submission rules
- Validate authorizations, referrals, and other payer requirements
- Confirm payer, member, provider, and service information is accurate
- Review and resolve claim rejections and denials
- Correct billing errors and resubmit claims when appropriate
- Research payer responses and denial codes
- Communicate recurring denial trends and billing issues to the Billing Lead
- Maintain accurate billing notes and claim documentation
- Perform billing quality checks and participate in internal billing audits
- Follow billing SOPs, payer requirements, Revenue Cycle policies, and privacy requirements
- Collaborate with Billing, Accounts Receivable, Authorization, Pharmacy, Operations, and other departments
- Assist with billing workflow improvements and clean claim rate increases
- Participate in training and process updates related to home infusion billing and payer requirements
Requirements:
- High school diploma or equivalent required
- Minimum 2 years of home infusion billing experience required
- Experience billing Medicare, Medicaid, and commercial insurance plans required
- Previous experience using CareTEND for home infusion billing required
- Experience with HCPCS/CPT coding, claim submission, payer guidelines, and denial resolution required
- Working knowledge of medical billing processes and payer requirements, with an understanding of home infusion billing practices
- Strong attention to detail and ability to identify discrepancies in billing information, units, charges, and claim data
- Ability to manage multiple priorities and meet daily and monthly billing deadlines
- Strong analytical and problem-solving skills, particularly when researching payer denials and claim issues
- Effective written and verbal communication skills and the ability to collaborate across multiple departments
- Ability to work independently in a remote environment while maintaining productivity, accuracy, and accountability
- Proficiency with billing systems, payer portals, Microsoft Office, and other Revenue Cycle technology
- Monday to Friday 8-5
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