Infusion Reimbursement Specialist

The Infusion Reimbursement Specialist is responsible for multiple areas that are key to success for Prochant, a billing service and process outsourcing company in the U.S. healthcare industry. The Infusion Reimbursement Specialist is responsible for the timely and accurate processing of claims. Following guidelines established by company policies, state or federally imposed billing requirements or insurance guidelines for best billing practices, including HIPAA.

The reimbursement specialist ensures clean claim submission to health plans. Reimbursement Specialist responsibilities include:

• Ensures receipt and validity of all documents needed in order to prepare and submit all billing and claims accurately.
• Responsible for understanding benefits verification and prior authorization, date spans, and HCPC unit calculations.
• Timely and accurate insurance claim submission, government, non-government, and third-party payors.
• Research claim denials and resolve associated AR in a timely manner
• Conducts frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers as needed.
• Providing, submitting, and coordinating all necessary documentation to be in compliance with payor requirements, including but not limited to, collaboration with internal teams, communication with external parties, and exchanging information with other business services as needed.

Requirements

• High school diploma or GED
• Deep knowledge and experience billing and collecting major medical claims for home infusion, ambulatory infusion, and/or specialty pharmacy.
• Two (2)+ years directly related Infusion and DME experience preferred.
• Experience using Bright Tree, CPR+, CareTend, or WeInfuse software.
• General knowledge of HCPCS, NDC, CPT, and ICD-10 coding.
• Ability to demonstrate a clear understanding of CMS 1500 and 837 claim formatting and billing process.