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 Billing Specialist with previous infusion billing experience, including biologic and specialty medication billing, J-codes, and payer reimbursement requirements, to support our growing infusion services. QUALIFICATIONS/EDUCATION: • High School Diploma required. • Minimum two (2) years of experience in medical billing and collections required. • Previous infusion billing experience required. • Experience billing biologic and specialty medications, infusion services, and J-codes required. • Knowledge of payer reimbursement requirements for infusion medications and services 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. • Strong knowledge of infusion billing, biologic and specialty medications, J-code billing, and payer reimbursement requirements. • Understanding of Medicare, Medicaid, and commercial payer billing requirements. • Ability to review infusion claims for appropriate coding, documentation, authorization, and reimbursement requirements. • Excellent communication, customer service, and telephone skills. • Strong organizational skills and ability to multitask effectively. • Ability to work independently with minimal supervision. • Ability to respect and maintain patient confidentiality at all times. • Dependable, professional, and detail-oriented. • Proficiency in Electronic Health Records, billing software, Microsoft Office applications, and other applicable systems. • Ability 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. • Prepare and submit claims for infusion services, biologic medications, and specialty medications, including applicable J-codes. • Review infusion claims for accuracy and compliance with payer-specific billing and reimbursement requirements. • Verify that required prior authorizations and referrals are obtained and appropriately documented before claim submission. • Review provider documentation, infusion records, and progress notes to ensure services and medications billed are supported by the medical record. • 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. • Research infusion-related denials, including issues involving authorization, medical necessity, coding, medication units, and payer reimbursement requirements. • 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. Qualified individuals, please submit your resume. We offer a competitive salary; Employee Health Insurance is covered at 100%. We also offer Dental, Vision, Life, and 401k Benefits.