Billing Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Examine patient accounts to ensure billing readiness and confirm the necessary documentation, authorizations, and charges.

• Prepare and submit claims for professional services, facilities, infusion, and pharmacy to payers while adhering to filing deadlines.

• Validate HCPCS, J-Codes, CPT, ICD-10, modifiers, units, and place of service codes.

• Process billing for infusion therapies, specialty pharmacy claims, and home infusion services in accordance with payer and regulatory standards.

• Monitor reports on claim transmissions, clearinghouse edits, payer edits, adjudication responses, and rejections.

• Investigate, rectify, and resubmit rejected claims within set turnaround times.

• Collaborate with pharmacy teams regarding prescriptions, dispensing, reimbursement, and coordination of benefits.

• Confirm prior authorizations and clinical documentation supporting billed services.

• Review charges for precision and completeness, identify any missing charges, and support revenue integrity.

• Work alongside intake, prior authorization, cash posting, accounts receivable, clinical, pharmacy, RCM, and client teams.

• Engage in client meetings, quality assurance audits, training, special projects, and initiatives for process improvement.

• Uphold HIPAA and billing regulation compliance, maintain detailed billing documentation, and follow company procedures.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• At least 1 year of preferred experience in healthcare billing.

• Experience with infusion services, specialty pharmacy, physician billing, hospital outpatient billing, or home infusion is preferred.

• Familiarity with Medicare, Medicaid, and commercial insurance billing is preferred.

• Knowledge of infusion-specific reimbursement methodologies is preferred.

• Strong comprehension of medical billing and reimbursement processes.

• Understanding of HCPCS, J-Codes, CPT, ICD-10, modifiers, and payer billing requirements.

• Knowledge of infusion drug reimbursement and billing for administration.

• Familiarity with specialty pharmacy billing and adjudication procedures.

• Understanding of claim submission, claim edits, and rejection management.

• Exceptional attention to detail and accuracy.

• Strong organizational and time management capabilities.

• Proficiency in EMR, practice management, and billing software systems.

• Intermediate skills in Microsoft Excel.

• Willingness to travel occasionally to client locations, internal meetings, and other necessary sites.

• Ability to uphold HIPAA and relevant billing regulation compliance.

🏝️ Benefits

• Health insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• 401k.

• Paid Time Off.