Billing Specialist

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. We offer a competitive salary; Employee Health Insurance is covered at 100%. We also offer Dental, Vision, Life, and 401k Benefits. #J-18808-Ljbffr GastroMed LLC