Infusion Reimbursement Specialist

Prochant; United States; On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Short Term Disability

Long Term Disability

Life Insurance

401K with company match

Pre-Paid Legal

Job summary

Prochant is seeking an Infusion Reimbursement Specialist to manage timely and accurate processing of infusion and DME claims in the U.S. healthcare billing environment.

You will verify benefits, handle prior authorizations, and ensure clean claim submission in compliance with CMS and payer guidelines. Ideal candidates have a high school diploma or GED, 2+ years in infusion/DME billing, and experience with Bright Tree, CPR+, CareTend, or WeInfuse.

Qualifications

• High school diploma or GED.
• Deep knowledge and experience billing and collecting major medical claims for home infusion, ambulatory infusion, and/or specialty pharmacy.
• 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.

Responsibilities

• Ensures receipt and validity of all documents needed to prepare and submit billing and claims accurately.
• Understand benefits verification, prior authorization, date spans, and HCPC unit calculations.
• Timely and accurate insurance claim submission to government, non-government, and third-party payors.
• Research claim denials and resolve associated AR in a timely manner.
• Conduct frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
• Provide, submit, and coordinate all necessary documentation to be in compliance with payor requirements and collaborate with internal/external teams.

Skills

Infusion billing

DME claims

Payer communication

CMS 1500/837

Coding knowledge

Education

High school diploma or GED

Tools

Bright Tree

CareTend

CPR+

WeInfuse

Job description

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.

• 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.

Prochant offers some of the best benefits in the industry! We take great care of our employees. Prochant’s Fortune 500 level benefits package includes:

• Health Insurance
• Gap Insurance
• Dental Insurance
• Vision Insurance
• Short Term / Long Term Disability (company paid)
• Term Life Insurance (company paid, employee can elect additional)
• Full suite of CHUBB supplemental insurance plans, including: Disability Income, Level Term Life, Accident Insurance, & Critical Illness Insurance

• Floating holidays and paid time off
• Pre-Paid Legal
• 401K with company match