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 candidate with infusion billing experience, including biologic and specialty medication billing, to support our growing infusion services.

QUALIFICATIONS/EDUCATION:

• High School Diploma required.
• Minimum 2 years of experience in medical billing and collections.
• Previous infusion billing experience required, including biologic and specialty medication billing.
• Experience with infusion claims, medication billing, J-codes, and payer reimbursement 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.
• Knowledge of infusion billing, biologic medications, J-code billing, and payer reimbursement guidelines.
• Understanding of Medicare, Medicaid, and commercial payer billing requirements.
• Excellent communication, customer service, and telephone skills.
• Strong organizational skills and ability to multi-task effectively.
• Must be able to work independently with minimal supervision.
• Ability to respect and maintain patient confidentiality at all times.
• Dependable, professional, and detail-oriented.
• Demonstrates proficiency in the use of personal computers, Electronic Health Records, billing software, and Microsoft Office applications.
• Must be able 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.
• Submit infusion and specialty medication claims accurately and in accordance with payer guidelines.
• Review claims to determine whether prior authorizations or referrals are required and ensure all necessary documentation is complete.
• 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.
• Review provider documentation and progress notes to ensure accurate billing and coding.
• 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.