Senior Infusion Reimbursement Specialist (Hybrid)

OSO Home Care, Inc.; Irvine (CA); Hybrid; USD 75,000 - 100,000; Full time

Job summary

OSO Home Care, Inc. is seeking an experienced Major Medical Collector to join our Billing & Reimbursement Department.

You will manage complex insurance accounts receivable for specialty home infusion pharmacy, infusion nursing services, and home health claims, in a hybrid work setup. You will maximize reimbursement by pursuing payment, resolving denials, and preparing appeals, collaborating with Intake, Authorization Specialists, Pharmacists, Nurses, Billing, Reimbursement, Managed Care, and

Qualifications

• Minimum 5 years of medical collections experience with a strong emphasis on specialty home infusion pharmacy.
• Experience with home health reimbursement strongly preferred.
• Experience managing high-dollar infusion claims and specialty medication reimbursement.
• CPR+ (Mediware), CareTend, Brightree, EnterpriseRx or similar billing platforms preferred.

Responsibilities

• Manage an assigned portfolio of complex insurance accounts receivable for specialty home infusion pharmacy and home health services.
• Review aging reports to prioritize collection activities.
• Research and resolve unpaid, underpaid, denied, and suspended claims.
• Monitor high-dollar infusion claims to ensure timely reimbursement.
• Identify reimbursement barriers and develop strategies to accelerate payment.
• Maintain productivity standards for insurance follow-up and collections.
• Conduct comprehensive insurance follow-up with Medicare, Medi-Cal, Managed Medi-Cal, and commercial plans.
• Communicate with insurance representatives regarding outstanding claims, appeals, and reimbursement issues.
• Resolve COB, eligibility issues, medical necessity denials, and contractual variances.
• Investigate denials, prepare appeals, and coordinate with clinicians to gather documentation.

Skills

Analytical thinking

Attention to detail

Time management

Negotiation

Communication

Excel

Multitasking

Education

High School Diploma or equivalent

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Medical Billing, or related field preferred

Tools

CPR+ (Mediware)

CareTend

Brightree

EnterpriseRx

Job description

OSO Home Care, Inc. is seeking an experienced Major Medical Collector to join our Billing & Reimbursement Department.

You will manage complex insurance accounts receivable for specialty home infusion pharmacy, infusion nursing services, and home health claims, in a hybrid work setup. You will maximize reimbursement by pursuing payment, resolving denials, and preparing appeals, collaborating with Intake, Authorization Specialists, Pharmacists, Nurses, Billing, Reimbursement, Managed Care, and