Infusion Billing & Physician Claims Specialist

American River Visiting Providers; Sacramento (CA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Health benefits

Paid time off

Billing training

Job summary

American River Visiting Providers is seeking a Physician Biller with infusion billing experience to manage physician billing, collections, and infusion billing. The role sits at the center of our revenue cycle and requires clear communication with clinical and front office teams to keep claims accurate and reduce denials.

You will verify insurance and Medicare eligibility, monitor labs needed for infusion therapies, post payments and adjustments, and coordinate with patients on balances and

Qualifications

• Two or more years of physician billing experience.
• Direct experience with infusion billing and collections.
• Working knowledge of Medicare and Medi-Cal billing rules for physician and infusion services.
• Familiarity with CPT, HCPCS, ICD 10, and J code billing for infused medications.
• Experience with prior authorization processes for infusion therapies.
• Understanding of Medicare coverage criteria for infused medications, including required labs and supporting documentation.
• Comfortable speaking with patients directly about balances, statements, and payment options.
• Strong organizational skills and attention to detail when managing multiple accounts.
• Experience with Athena platform preferred.
• Clear written and verbal communication skills.

Responsibilities

• Prepare, submit, and track physician professional claims for Medicare, Medi-Cal, and commercial payers.
• Manage specialty infusion billing and collections, including prior authorization follow up, J code and HCPCS accuracy, and payer specific infusion billing rules.
• Work accounts receivable for physician and infusion services, following up on unpaid and underpaid claims until resolution.
• Research and resolve claim denials and rejections, correcting and resubmitting claims within payer timelines.
• Review coding and documentation for billing accuracy, coordinating with providers and coding staff as needed.
• Serve as a patient facing point of contact for billing questions, payment plans, and statement disputes, delivering every interaction with patience and professionalism.
• Verify insurance benefits and eligibility for physician and infusion visits when needed to support clean claims.
• Verify Medicare eligibility and confirm patients meet Medicare coverage criteria for infused medications before billing.
• Monitor that required lab work is received and on file to support medical necessity for infusion therapies.
• Confirm that orders from the referring physician are valid, current, and properly signed before products are orders and services are billed.
• Post payments, adjustments, and denials accurately, and reconcile accounts against remittance advice.
• Track key collections metrics and flag trends or payer issues to leadership.
• Maintain compliance with Medicare, Medi-Cal, and payer billing regulations, including timely filing and documentation standards.

Skills

Infusion billing

Medicare/Medi-Cal rules

Patient communication

Organizational skills

Athena platform

Attention to detail

Tools

Athena platform

Job description

American River Visiting Providers is seeking a Physician Biller with infusion billing experience to manage physician billing, collections, and infusion billing. The role sits at the center of our revenue cycle and requires clear communication with clinical and front office teams to keep claims accurate and reduce denials.

You will verify insurance and Medicare eligibility, monitor labs needed for infusion therapies, post payments and adjustments, and coordinate with patients on balances and