Reimbursement Specialist

Oso Home Care Inc.; California (MO); On-site; USD 60,000 - 85,000; Full time

Job summary

Oso Home Care Inc. is seeking an experienced Home Infusion Biller to join our Billing & Reimbursement Department in Southern California. You will handle billing for home infusion pharmacy, infusion nursing visits, and ambulatory infusion center (AIC) services, ensuring accuracy and timely reimbursement.

The role requires familiarity with Medicare, Medi-Cal, and commercial payers, along with documentation controls, denial management, and payer follow-up to optimize revenue cycle performance.

Qualifications

• 2 years of medical billing or collections experience in Home Infusion, Specialty Pharmacy, Home Health, or Infusion Services.
• Experience with CPR+ (Mediware) or CareTend preferred.
• Experience billing Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, and commercial insurance plans.

Responsibilities

• Prepare, review, and submit accurate electronic and paper claims for home infusion pharmacy services, infusion nursing visits, ambulatory infusion center (AIC) treatments, specialty medications, and related services.
• Ensure all billing is supported by physician orders, nursing documentation, delivery records, medication administration records, and required clinical documentation.
• Submit claims utilizing appropriate HCPCS, CPT, ICD-10-CM, NDC, modifiers, and payer-specific billing requirements.
• Review claims for completeness and accuracy prior to submission.
• Monitor claim acceptance and payment status through payer portals and electronic remittance systems.
• Research denied and partially paid claims and prepare corrected claims for resubmission.
• Maintain detailed documentation of all payer communications and account activity.

Skills

Medical Billing

Revenue Cycle

HIPAA Compliance

Education

Associate degree in Medical Billing / Healthcare Administration

Tools

CPR+ (Mediware)

CareTend

Job description

Job Description

Position Summary

Oso Home Care is seeking an experienced Home Infusion Biller to join our Billing & Reimbursement Department. Since 1984, Oso Home Care has been a leader in specialty home infusion pharmacy, ambulatory infusion center (AIC) services, and home health throughout Southern California.

The Home Infusion Biller is responsible for the accurate and timely billing of specialty infusion pharmacy medications, supplies, nursing services, and ambulatory infusion center (AIC) services. This position manages the billing process from claim creation through reimbursement by ensuring claims are submitted accurately, claim edits are resolved, denials are appealed, and insurance follow-up is completed in accordance with payer requirements.

The Home Infusion Biller works closely with Intake, Authorization Specialists, Benefits Verification, Pharmacy, Nursing, Reimbursement, and Revenue Cycle teams to ensure complete documentation, accurate billing, and timely reimbursement while maintaining compliance with Medicare, Medi-Cal, commercial insurance, and accreditation standards.

Essential Duties and Responsibilities: Medical Billing

• Prepare, review, and submit accurate electronic and paper claims for home infusion pharmacy services, infusion nursing visits, ambulatory infusion center (AIC) treatments, specialty medications, and related services.
• Ensure all billing is supported by physician orders, nursing documentation, delivery records, medication administration records, and required clinical documentation.
• Submit claims utilizing appropriate HCPCS, CPT, ICD-10-CM, NDC, modifiers, and payer-specific billing requirements.
• Review claims for completeness and accuracy prior to submission.
• Ensure claims are billed within established departmental turnaround standards.

Claim Processing

• Review electronic claim edits and clearinghouse reports.
• Correct billing errors and resubmit rejected claims.
• Resolve claim edits related to coding, documentation, eligibility, authorization, or payer requirements.
• Monitor claim acceptance and payment status through payer portals and electronic remittance systems.

Denial Resolution

• Research denied and partially paid claims.
• Determine the cause of denials and implement corrective actions.
• Prepare corrected claims and supporting documentation for resubmission.
• Submit appeals when appropriate and monitor payer response timelines.
• Collaborate with Intake, Authorization Specialists, Pharmacy, Nursing, and physician offices to obtain additional documentation needed for reimbursement.

Insurance Follow-Up

• Follow up on outstanding claims with Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, and commercial insurance carriers.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) for payment accuracy.
• Resolve claim payment discrepancies, coordination of benefits (COB), underpayments, and contractual adjustments.
• Maintain detailed documentation of all payer communications and account activity.

Revenue Cycle Collaboration

• Work collaboratively with Intake, Authorization, Benefits Verification, Pharmacy, Nursing, and Reimbursement teams to resolve billing issues that impact reimbursement.
• Identify trends that contribute to billing delays or denials and communicate recommendations for process improvement.
• Assist with payer audits, documentation requests, and reimbursement reviews.

Compliance

• Maintain compliance with:
  • Medicare and Medi-Cal billing regulations
  • Commercial payer billing requirements
  • CMS reimbursement guidelines
  • HIPAA Privacy and Security Rules
  • ACHC accreditation standards
  • California Board of Pharmacy regulations
  • Company policies and procedures
• Maintain confidentiality of patient health information in accordance with HIPAA.

Minimum Qualifications

• High School Diploma or equivalent required.
• Associate degree in Medical Billing, Healthcare Administration, or related field preferred.
• Minimum of 2 years of medical billing or collections experience in Home Infusion, Specialty Pharmacy, Home Health, or Infusion Services.
• Experience with CPR+ (Mediware), CareTend, or similar healthcare billing software preferred.
• Experience billing Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, and commercial insurance plans.

Knowledge, Skills & Abilities

• Thorough knowledge of medical billing procedures and revenue cycle processes.
• Worki