Infusion & Specialty Reimbursement Specialist

CLS Health PLLC; Webster (TX); On-site; USD 65,000 - 90,000; 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 PLLC, a Houston-based healthcare system, is seeking a skilled Revenue Cycle Specialist focused on infusion and specialty drug claims. The role aims to recover revenue by auditing payments, identifying denial causes, and coordinating with payers, manufacturers, and internal teams.

Candidates should have 3+ years in medical billing or revenue cycle, with knowledge of J-codes, NDC, and buy-and-bill practices. Excel and payer portals experience are required; Power BI is a plus.

Qualifications

• 3+ years in medical billing, reimbursement, or revenue cycle with direct experience in infusion or specialty drug claims.
• Working knowledge of J-codes, NDC and unit billing, buy and bill, specialty pharmacy, and medical vs pharmacy benefit.
• Able to read payer policies, fee schedules, and EOBs and explain a denial in plain terms.
• Experience with copay assistance and manufacturer reimbursement reconciliation.
• Comfortable with Excel and payer portals; Power BI or reporting experience is a plus.
• Coding certification (CPC or similar) is a plus.

Responsibilities

• Monitor unbilled and unpaid infusion and specialty medication encounters and keep claims moving to timely submission.
• Audit paid claims against expected reimbursement using payer fee schedules and drug allowables (ASP, WAC, contracted rates).
• Work denials and underpayments and identify the cause: authorization, benefits or site-of-care restriction, coding or NDC/unit errors, documentation gaps, or copay assistance that was never reimbursed.
• Call payers to confirm coverage, fee schedule, and buy and bill vs specialty pharmacy requirements for specific medications.
• Reconcile copay card and foundation assistance payments and follow up on outstanding manufacturer reimbursements.
• Coordinate corrections and rebills with billing and the intake team, and feed findings back into the intake process so the same denial doesn't recur.
• Report payer and drug-level profitability and denial trends to the Ancillary Services Manager.

Skills

Medical billing

Revenue cycle management

J-codes

NDC

Buy and bill

Power BI

Excel

Payer portals

Copay assistance

Communication

Education

CPC certification

Tools

Power BI

Excel

Job description

CLS Health PLLC, a Houston-based healthcare system, is seeking a skilled Revenue Cycle Specialist focused on infusion and specialty drug claims. The role aims to recover revenue by auditing payments, identifying denial causes, and coordinating with payers, manufacturers, and internal teams.

Candidates should have 3+ years in medical billing or revenue cycle, with knowledge of J-codes, NDC, and buy-and-bill practices. Excel and payer portals experience are required; Power BI is a plus.