Infusion Reimbursement Specialist: Claims & Denials Expert

Prochant-US; United States; On-site; USD 52,000 - 75,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Short Term Disability

Long Term Disability

401K with company match

Pre-Paid Legal

Job summary

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

You will manage benefits verification, prior authorizations, and accurate coding (HCPCS, NDC, CPT, ICD-10) while submitting claims to various payors and addressing denials. The role requires a high school diploma or GED and 2+ years of infusion billing experience, with proficiency in Bright Tree, CPR+, CareTend, or WeInfuse.

Qualifications

• High school diploma or GED is required.
• Deep knowledge and experience billing and collecting major medical claims for home infusion, ambulatory infusion, and/or specialty pharmacy.
• Two or more years of infusion and DME experience preferred.
• Experience with HCPCS, NDC, CPT, and ICD-10 coding.
• Clear understanding of CMS 1500 and 837 claim formatting and billing process.

Responsibilities

• Ensure receipt and validity of documents needed to prepare and submit billing and claims accurately.
• Understand benefits verification and prior authorization, data spans, and HCPCS unit calculations.
• Submit insurance claims to government, non-government, and third-party payors in a timely and accurate manner.
• Research claim denials and resolve AR in a timely manner.
• Conduct frequent phone contacts with provider representatives, third party customer service representatives, pharmacy staff, and case managers as needed.
• Coordinate and provide all necessary documentation to comply with payor requirements, collaborating with internal teams and external parties.

Skills

Billing knowledge

Claims processing

Attention to detail

HIPAA compliance

Education

High school diploma or GED

Tools

Bright Tree

CPR+

CareTend

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