Infusion & Specialty Medication Reimbursement Pro

CLS; Webster (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

401(k) matching

Dental Insurance

Disability insurance

Health insurance

Life insurance

Paid time off

Job summary

CLS Health, a Houston-based multispecialty provider, seeks a Revenue Cycle Specialist to audit infusion and specialty medication claims, identify root causes of denials, and work with payers and internal teams to maximize reimbursements.

Responsibilities include monitoring pay-to-submit cycles, auditing reimbursements, and coordinating corrections with billing and intake. Experience in infusion claims and payer portals is preferred, CPC or similar certification is a plus.

Qualifications

• 3+ years in medical billing, reimbursement, or revenue cycle with infusion or specialty drug claims experience
• Able to read payer policies, fee schedules, and EOBs and explain denials clearly
• Experience with copay assistance and manufacturer reimbursement reconciliation

Responsibilities

• Monitor unbilled and unpaid infusion and specialty encounters to keep claims moving for timely submission
• Audit paid claims against expected reimbursement using payer fee schedules and drug allowables
• Work denials and underpayments and identify root causes: authorization, benefits, site-of-care, or coding errors
• Call payers to confirm coverage, fee schedule, and buy-and-bill vs specialty requirements for meds
• Reconcile copay card and foundation assistance payments and follow up on manufacturer reimbursements
• Coordinate corrections and rebills with billing and intake, feeding findings back to prevent recurring denials
• Report payer and drug-level profitability and denial trends to Ancillary Services Manager

Skills

Medical billing

Denials management

Excel

Payer policies

Reading EOBs

Education

CPC certification

Medical billing certification

Tools

Excel

Power BI

Payer portals

Job description

CLS Health, a Houston-based multispecialty provider, seeks a Revenue Cycle Specialist to audit infusion and specialty medication claims, identify root causes of denials, and work with payers and internal teams to maximize reimbursements.

Responsibilities include monitoring pay-to-submit cycles, auditing reimbursements, and coordinating corrections with billing and intake. Experience in infusion claims and payer portals is preferred, CPC or similar certification is a plus.