Reimbursement Specialist (3847)

Position Summary 

Be knowledgeable in all aspects of reimbursement from intake, billing, collections, and insurance verification. Assists Reimbursement Manager with collections and billing. Ensures timely, accurate submission of all claims and collection of all patient accounts.  Has a thorough understanding of all Payer Contracts. 

Essential Job Functions 

• Ensures timely, accurate submission and collection of claims.  

• Speaks knowledgeably regarding reimbursement issues   

• Bills all charges on a daily basis.                                                                                                

• Distributes and works all denials on a daily basis including documenting complete comprehensive AR notes.     

• AR Notes- document all conversations, ref #, Phone number called, who you spoke to.                                            

• Notifies patients/ caregivers regarding coverage and payment responsibilities.  Communicates insurance limitations and co-payment responsibilities. 

• Processes all electronic claims through clearinghouse. 

• Demonstrates professional demeanor when interacting with clients, insurance companies, referral sources and Infusion Solutions staff.    

• Speaks knowledgeably to the scope of services that Infusion Solutions can provide.  

Duties, responsibilities, and activities may change at any time with or without notice to meet organizational needs. 

Supervisory Responsibilities 

• This position does not have direct supervisory responsibilities. 

Required Education, Licensure & Experience 

All requirements below are job-related and consistent with business necessity. 

• Minimum of two (2) years of medical billing experience.  

• Experience with billing major medical claims.  

• Prepare and submit clean claims to assigned insurance companies.  

• Thorough understanding of converting vials into units and vice versa per the payer’s fee schedule.  

• Ability to submit and correct claims via various clearinghouses.  

• Knowledge of payer contracts and fee schedules (per diems, AWP’s, NDC#’s, etc.). 

Preferred Education & Experience 

Preferred qualifications are not required but are job-related and consistent with business necessity. 

• Prior experience in home infusion billing.  

• Proficiency in CPR+ or CareTend systems.  

• Experience working with Pharmacy Benefit Managers (PBMs). 

Core Competencies 

• Excellent written and verbal communication skills.  

• Exceptional customer service skills.  

• Ability to apply common sense and understanding to carry out instructions in written, oral, and diagram form.  

• Strong problem-solving skills for situations involving multiple variables.  

• Professional demeanor in interactions with clients, insurance companies, and referral sources.  

• Computer proficiency.  

• Knowledge of medical terminology, Medicare, Medicaid, and third-party payer guidelines.  

• Ability to prepare and submit clean claims to insurance companies.  

• Understanding of payer contracts, fee schedules (per diems, AWP’s, NDC#’s, etc.), and claim corrections via clearinghouses.  

• Experience converting vials into units and vice versa per payer fee schedules. 

Physical Demands 

The following physical demands are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made where appropriate.  

• Frequent standing, walking, sitting, talking, and hearing.  

• Regular use of hands for handling, pushing/pulling, stooping, kneeling, reaching, and grasping (both light and firm).  

• Ability to lift and exert force with objects up to 100 pounds.  

• Fine motor dexterity and repetitive motion with hands and feet required.  

• No special vision requirements; standard visual abilities sufficient. 

• Frequent use of hands and fingers for typing, data entry, and computer-related tasks (both right and left hand).  

• Repetitive grasping (light) and fine motor dexterity required for keyboarding, mouse use, and document handling.  

• Minimal use of feet for foot controls (if any office equipment requires it). 

Work Environment 

• Primarily an office/desk-based environment.  

• Typical noise levels are quiet to moderate.  

• Minimal exposure to physical hazards; standard office equipment used.  

• Work may require occasional interaction with clients, colleagues, and insurance representatives.  

• Reasonable accommodations provided for individuals with disabilities. 

Additional Eligibility Requirements 

• Must pass a pre-employment background check and drug screen per company policy and applicable state law. 

• Must maintain required immunizations per accreditation standards and company policy. 

• Must provide proof of eligibility to work in the U.S. 

• Must comply with company policies, codes of conduct, and required trainings. 

• Must hold required licenses or certifications, if applicable. 

• Must be available for required shifts or travel, if applicable. 

• Must meet role-specific physical, technical, or experience requirements, if applicable.