RCM Operations Specialist, Infusion (AI Platform)

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

About Trellis
Trellis builds AI that handles intake, benefits, prior authorization and reimbursement for infusion and specialty pharmacy providers, so patients start therapy faster and providers get paid for it.

The role
You will be our expert on infusion prior authorization and reimbursement. Our system reads referrals, clinical notes and payer policies, then prepares the work that intake and reimbursement teams do by hand today. Your job is to make sure that work is right. You will review real cases across our customers, catch what the system gets wrong and explain why. Then you turn that judgment into rules and test cases our engineers build on. You will work directly with the product and engineering team.

What you will do

• 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

What you bring

• 3+ years in infusion or specialty pharmacy revenue cycle, such as prior authorization, benefits verification, billing, denials or appeals

• Working knowledge of medical versus pharmacy benefit, buy and bill, HCPCS J codes, administration CPT codes, NDC to billing unit conversion and modifiers

• Comfort reading LCDs, NCDs and commercial medical policies and applying them to a specific patient

• Experience with payer portals and PA tools such as Availity or CoverMyMeds, and pharmacy or infusion systems such as CPR+ or WellSky

• Careful judgment. You know the difference between what the chart says and what someone assumed

• Clear writing. You can explain a denial risk in two sentences to someone who has never billed a claim

Nice to have

• A CPC, CPB, CRCS or similar certification, or a pharmacy technician or nursing background

• Experience at a home infusion provider, ambulatory infusion center or specialty pharmacy

• Experience with biologics, IVIG and other high cost therapies across Medicare, Medicaid and commercial plans

• Curiosity about how AI can change healthcare operations. No coding required

About the interview

1. Intro call with Ahmed (30 min). Your background, the kind of reimbursement work you have done, and what you want next.

2. Case review exercise (60 to 90 min). We share two or three anonymized infusion referrals with the relevant payer policy. You decide whether a PA is needed, whether the case meets coverage criteria, and how it should be billed. Then we go through your reasoning together. We care more about how you think and where you look than about a perfect answer.

3. Team conversations (45 min). Meet the people on product and engineering you will work with every day, and ask anything about how we build.

4. References and offer. We move quickly and will tell you where you stand after each step.

Compensation & Benefits

The salary range above is our good-faith estimate. Your final level and base salary will reflect what you bring: your skills, your experience, and how much ownership you’re ready to take on. Base pay is only one part of the package. Every full-time teammate also gets meaningful equity, because the people building Trellis should share in what it becomes. We are committed to keeping you healthy and supported so you can do the best work of your career. Here are some of the benefits & perks we offer:

• Comprehensive medical, dental, and vision coverage

• Flexible PTO & Sick Time

• Daily meals in the office

• Team offsites

Equal Opportunity at Trellis

At Trellis, we’re building AI agents that help patients get life-saving medicine faster. The patients and providers we serve come from every background, and our team should too. Trellis is an Equal Opportunity Employer. We hire based on talent, curiosity, and drive, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic.

If you need an accommodation at any point in our hiring process, let your recruiter know and we’ll take care of it.