Infusion RCM Specialist - AI-Driven Reimbursement

Trellis AI; United States; Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Flexible PTO

Daily meals in the office

Team offsites

Equity participation

Job summary

Trellis AI is seeking an expert on infusion prior authorization and reimbursement. You will review real cases from our customers, judge the right outcome, and translate that into rules and test cases for our engineers, while collaborating with product and engineering.

You will review PA and reimbursement cases, check payer policies, LCDs and NCDs, and document the reasoning and sources. You’ll build an ongoing library of payer rules, identify patterns in errors, and communicate findings to

Qualifications

• 3+ years in infusion or specialty pharmacy revenue cycle.
• Experience with payer policies and medical necessity determinations.
• Familiarity with LCDs/NCDs and payer portals.

Responsibilities

• Review prior authorization and reimbursement cases for infusion customers, covering benefits, coverage, PA requirements, medical necessity, billing codes and units.
• Check each decision against payer policies, Medicare LCDs and NCDs, payer portals and the patient's clinical documentation.
• Build answer keys that record the correct outcome for real cases, with the reasoning and source behind each call.
• Find patterns in errors and write them up clearly for product and engineering, with examples.
• Keep a working library of payer rules, drug coverage criteria and billing conventions up to date.
• Learn how customer intake and reimbursement staff handle edge cases, and bring those conventions into the product.
• Review early output during customer onboarding and flag risk before it reaches a claim.

Skills

Infusion revenue cycle

Payer policies interpretation

Payer portals experience

Clear writing

Rule creation

Tools

Availity

CoverMyMeds

CPR+

WellSky

Job description

Trellis AI is seeking an expert on infusion prior authorization and reimbursement. You will review real cases from our customers, judge the right outcome, and translate that into rules and test cases for our engineers, while collaborating with product and engineering.

You will review PA and reimbursement cases, check payer policies, LCDs and NCDs, and document the reasoning and sources. You’ll build an ongoing library of payer rules, identify patterns in errors, and communicate findings to