Descripción del puesto
Medical center in USA seeks a new team of Billing Specialist with experience in
Medical billing Technical Skills:
Minimum 6 months of experience in Healthcare billing
CPT - ICD 10 codes
HIPPA Schedule: Full time, Monday to Friday 8:00am - 5:00pm EST
Schedule: Monday to Friday, 8:00am - 5:00pm EST
Salary: 1,200 USD per month English C1 Key Responsabilities
1. Claims Management & Follow-Up
Monitor infusion claims from submission through final payment.
2. Denials & Appeals
Analyze infusion claim denials (e.g., prior authorization missing, bundling issues, incorrect J-codes).
Correct and resubmit denied claims accurately and timely.
Prepare and submit appeals with required clinical documentation (physician orders, progress notes, infusion logs).
Track appeal outcomes and escalate unresolved issues when necessary.
3. Payment Posting & Reconciliation
Review ERAs/EOBs to ensure accurate payment for infusion CPT and HCPCS J-codes.
Identify underpayments based on contract rates.
Reconcile posted payments against expected reimbursement.
Coordinate with payment posting teams to correct discrepancies.
4. Prior Authorizations & Medical Necessity Support
Verify that infusion services have valid prior authorizations when required.
Work with authorization teams to resolve retro-authorization issues.
Ensure documentation supports medical necessity for drugs and administration services.
5. Payer Communication
Communicate with insurance carriers regarding claim status, denials, and reimbursement issues.
Document all payer interactions clearly in the billing system.
Maintain knowledge of payer-specific infusion billing rules and policies.
6. Patient Balances & Coordination
Identify patient responsibility after insurance processing.
Coordinate with patient billing teams regarding copays, deductibles, and coinsurance.
Assist with insurance corrections or secondary billing as needed.
7. Compliance & Accuracy
Ensure compliance with CMS, Medicare, Medicaid, and commercial payer guidelines.
Follow HIPAA and confidentiality standards.
Verify accurate use of CPT codes, HCPCS J-codes, modifiers (e.g., -59, -JW), and units.
8. Reporting & Productivity
Maintain AR aging reports for infusion services.
Prioritize high-dollar and high-aging infusion claims.
Meet productivity and turnaround time standards.
Report recurring issues affecting reimbursement to management.
9. Collaboration
Work closely with coding, clinical, authorization, and intake teams.
Provide feedback on documentation or coding issues impacting infusion reimbursement.
Support process improvements to reduce denials and improve cash flow.
Follow up on unpaid, underpaid, or denied claims within payer-specific timelines.
Research claim status using payer portals, EOBs/ERAs, and clearinghouse tools.
Identify trends in denials related to infusion services (e.g., medical necessity, authorization, coding).
If you want to follow the process, we need your english cv:
Phone number:
E-mail:
Current salary:
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Requisitos
- Minimum 6 months of experience in Healthcare billing
- English C1