Revenue Cycle Specialist - Pharmacy Biller

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering specialized care for patients needing IV therapy and specialty pharmacy services in the homecare setting. The company fosters an ethical, team-oriented, and quality work environment that promotes achievement and success.

As a Revenue Cycle Specialist - Pharmacy Biller, you will manage multiple facets of the pharmacy/infusion reimbursement process by interacting with insurance companies and patients to ensure accurate payment. Responsibilities include investigating irregularities, resolving problem claims, filing claims, billing, appeals, reviews, customer service, and overall revenue cycle management.

Candidates should have at least 2 years of infusion billing experience, strong customer service skills, adaptability, excellent problem-solving abilities, leadership qualities, and a results-oriented mindset.

Key duties:

• Prepare and submit clean claims electronically or by paper
• Follow up on unpaid claims and prepare appeals or corrected claims
• Submit claims to Medicare with appropriate coding and documentation
• Stay updated on Medicare regulations and policies
• Collaborate with management, patients, and Medicare representatives to resolve issues
• Review Explanation of Benefits (EOBs) and manage revenue and reporting
• Submit write-off requests and identify bad debt
• Accurately bill payor and patient responsibility amounts timely
• Handle phone communications regarding billing and statements
• Interpret contracts and maintain payor relationships
• Provide excellent customer service

Skills and qualifications:

• Home infusion and Medicare billing experience (minimum 5 years Medicare billing)
• Strong knowledge of government and managed care insurance plans
• Experience with claims adjudication and insurance negotiations
• Interaction with pharmacists and intake departments to resolve claims
• Accurate and detail-oriented under pressure
• Proficiency in Microsoft Office
• Effective oral and written communication
• Problem-solving and critical thinking
• Experience with computerized billing systems, CPR+ Infusion Pharmacy software preferred
• Knowledge of Medicare and Medicaid guidelines for home infusion therapy
• Familiarity with infusion CPT, HCPCS, and ICD-10 codes
• Electronic claim filing and medical billing compliance

Physical demands include standing, walking, sitting, talking, hearing, occasional lifting up to 25 lbs, and necessary vision requirements. Reasonable accommodations may be provided.

InfuCare Rx is an equal opportunity employer committed to diversity and non-discrimination. Background checks and drug screenings are part of the hiring process.