Infusion and Specialty Drug Revenue Cycle Specialist

Role Description

The Infusion and Specialty Drug Revenue Cycle Specialist is responsible for managing the accounts receivable (AR) processes related to physician-administered drugs, including infusion therapies, injectable medications, and buy-and-bill pharmaceuticals. This includes:

• Verifying insurance coverage
• Submitting claims for drugs billed under the medical benefit
• Resolving billing discrepancies
• Ensuring timely reimbursement from payers

This role requires collaboration with pharmacy teams, clinical staff, healthcare providers, and insurance companies to streamline the revenue cycle and minimize denials.

Qualifications

• High School Diploma or equivalent (higher degree accepted)
• 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

Requirements

• 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.
• 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.
• Confirm insurance eligibility and coverage for infusion therapies and physician-administered drugs.
• Collaborate with pharmacy and clinical teams to obtain prior authorizations when required.
• Ensure claims comply with payer policies, coding standards, and regulations.
• Maintain organized and accurate documentation for audit purposes.
• Identify opportunities to optimize the infusion and medical benefit drug billing process.
• Implement solutions to enhance efficiency and reduce denials.

Benefits

• 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.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.