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:
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[email protected] or +1 (407) 604-1771