Billing Specialist LEAD- Remote Home Infusion

Advanced Infusion Care (AIC) is a leading provider of home infusion and IG therapy, serving patients through six pharmacy locations. Guided by our values of Innovation, Stewardship, and Unity, we are committed to advancing quality and improving lives through exceptional products, services, and patient care.

The Billing Lead is a full-time position responsible for assisting in leading the billing operations for Advanced Infusion Care. Billing processes for home infusion and IG services run from delivery ticket confirmation through accurate, timely submission of electronic and paper HCFA 1500 claims to third-party payers, including rejection management and corrected claims. The Billing Lead serves as a subject matter expert and escalation point for the billing team, routinely performs quality reviews, trains and re-trains staff, and supports team members in problem solving and resolution of billing issues. The Billing Lead works closely with Pharmacy, Collections, and other Revenue Cycle Management teams to prevent denials and support timely reimbursement. Also performs duties of an Infusion Billing Specialist.

•          A high school diploma or general education degree (GED) equivalent is required; bachelor’s degree preferred.

•          Minimum of 5 years of healthcare industry experience required.

•          Minimum of 3 years of home infusion billing experience required; IG experience preferred.

•          Prior experience in a lead, trainer, or mentor role preferred.

•          Medical coding knowledge and experience preferred.

•          Experience with Waystar or a similar claims-management platform preferred.

•          Assists in overseeing the daily operations of the billing team, including delivery ticket review, billing holds, claim submission, rejections, corrected claims, and staff productivity and quality.

•          Serves as the Subject Matter Expert (SME) for all billing processes and as the escalation point for complex or aged billing issues.

•          Reviews and follows up on open pharmacy delivery tickets to ensure timely and accurate billing.

•          Monitors and resolves claims identified on billing hold reports; escalates unresolved items as necessary.

•          Prepares and submits accurate electronic and paper HCFA 1500 claims.

•          Works rejected claims queues in Waystar and resolves issues for timely resubmission; researches and submits corrected claims as needed.

•          Reviews claims for billing accuracy, including payer requirements, coding, NDCs, units, quantities, and infusion supplies.

•          Performs routine quality reviews of billed claims, identifies errors and trends, and works with staff and other departments to correct root causes.

•          Partners with the Collections team to identify billing-related causes of denials and rejections and implements process improvements to prevent recurrence.

•          Responds timely and accurately to questions from the Collections team, Pharmacy, and other internal departments.

•          Maintains contact with other departments to obtain patient, order, or insurance information needed for claim submission and payment.

•          Assists in creating and updating billing training modules and procedures.

•          Assists with training new and existing employees and provides coaching and re-training when quality issues are identified.

•          Supports team members in problem solving and resolution as related to payer requirements and claim issues.

•          Participates in the development and implementation of operating policies and procedures.

•          Maintains accurate and thorough documentation of billing activities, including calls, contacts, and resolutions.

•          Ensures billing activities are conducted consistent with overall department protocol and in compliance with Federal and State regulations and payer requirements, guidelines, and policies.

•          Maintains working knowledge of payer policies, reimbursement requirements, insurance plans, medical terminology, billing procedures, government regulations, and medical codes.

•          Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.

•          Maintains the strictest confidentiality and adheres to all HIPAA guidelines and regulations.

•          Recognizes patients’ rights and responsibilities and supports them in the performance of job duties; respects patients’ rights to privacy and confidentiality.

•          Shares knowledge gained with other staff members and works as a team member.

•          Interacts with others in a positive, respectful, and considerate manner.

•          Performs other job-related duties as assigned.

•          Strong understanding of all Revenue Cycle Management functions and how they integrate across the billing and collections process.

•          Ability to recognize, evaluate, and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.

•          Strong analytical and problem-solving skills with the ability to make timely, sound decisions.

•          Excellent verbal and written communication and relationship-building skills, with the ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.

•          Exceptional attention to detail and accuracy.

•          Strong work ethic with personal qualities of integrity, accountability, and credibility.

•          Ability to deal with highly sensitive and confidential material; strong knowledge of HIPAA privacy guidelines and requirements.

•          Working knowledge of ICD-10 coding and knowledge of medical terminology.

•          Ability to assist in leading a team in an environment with frequent changes and priorities.

•          Ability to train employees, including organizing, prioritizing, and scheduling work assignments to meet timelines.

•          Self-directed, organized, dependable, and able to follow through; able to work independently in a remote environment.

•          Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.

•          Skill in establishing and maintaining effective working relationships with other employees, organizations, and the public.

•          Tolerant of frequent interruptions from staff and other internal support teams.

•          Proficient in Microsoft Office, including Outlook, Word, and Excel.