[Hiring] Home Infusion Billing Specialist @Infusion4Health Inc

Role Description

The Home Infusion Billing Specialist is responsible for accurate and timely claim submission and billing for home infusion services, medications, supplies, and related administration. This position reviews billing documentation, verifies payer-specific requirements, applies appropriate coding and billing information, and submits clean claims to Medicare, Medicaid, and commercial payers. The role works closely with the billing, authorization, pharmacy, operations, and accounts receivable teams to resolve billing issues, reduce denials, and support timely reimbursement.

Key Responsibilities

• Review home infusion charges, billing records, orders, authorizations, and supporting documentation for completeness and accuracy prior to claim submission.
• Prepare and submit clean claims to Medicare, Medicaid, and commercial payers within established billing timelines.
• Accurately bill home infusion medications, supplies, administration services, and applicable per diem or related services based on payer requirements.
• Apply appropriate HCPCS/CPT codes, units, modifiers, NDC information, place of service, and other claim elements when required.
• Validate drug quantities, dosage units, dates of service, and billing units against the available billing documentation.
• Identify missing or inconsistent information that may result in claim rejection or denial and coordinate corrections before submission.

Payer Requirements & Authorization

• Review payer-specific billing guidelines, fee schedules, coverage requirements, and claim submission rules applicable to home infusion services.
• Validate that required authorizations, referrals, and other payer requirements are documented and applicable to the billed service.
• Confirm payer, member, provider, and service information is accurate and consistent with the claim and billing system.
• Identify payer-specific requirements related to modifiers, drug billing, units, waste, administration, per diem services, and supporting documentation.
• Escalate unresolved authorization or payer-related issues to the appropriate department to prevent avoidable billing delays.

Denials, Rejections & Billing Follow-Up

• Review claim rejections and denials related to billing accuracy, coding, authorization, eligibility, payer requirements, and documentation.
• Correct billing errors and resubmit claims promptly when appropriate.
• Research payer responses and denial codes to determine the appropriate corrective action.
• Communicate recurring denial trends and billing issues to the Billing Lead for review and process improvement.
• Maintain accurate billing notes and documentation of actions taken on claims.

Quality & Compliance

• Perform billing quality checks to ensure claims are accurate, complete, and supported by the available documentation.
• Follow established billing SOPs, payer requirements, and Revenue Cycle policies.
• Protect patient information and maintain confidentiality in accordance with organizational policies and applicable privacy requirements.
• Participate in internal billing audits and corrective action initiatives as assigned.
• Meet established productivity, accuracy, and timeliness expectations while maintaining a high level of attention to detail.

Team Collaboration

• Collaborate with Billing, Accounts Receivable, Authorization, Pharmacy, Operations, and other departments to resolve claim issues.
• Communicate billing concerns clearly and professionally and provide timely follow-up on outstanding items.
• Assist with identifying opportunities to improve billing workflows, reduce recurring errors, and increase clean claim rates.
• Participate in training and process updates related to home infusion billing and payer requirements.

Qualifications

• High school diploma or equivalent required; additional healthcare or business education preferred.
• 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.

Knowledge, Skills, and Abilities

• 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.

Schedule

Monday to Friday, 8-5