About the Role: Are you an RCM professional with specialized experience in Oncology, Hematology, or Infusion Billing We are looking for a detail-oriented Billing & AR Specialist to manage end-to-end revenue cycle operations for a premier U.S.-based specialty practice.
In this role, you will play a crucial part in managing high-dollar drug billing, securing prior authorizations, resolving complex claim denials, and ensuring seamless reimbursement for life-saving treatments.
Key Responsibilities:
- J-Code & Infusion Billing: Accurately code and submit claims for specialty drugs, chemotherapy, and infusion therapies using appropriate CPT, HCPCS (J-Codes), and ICD-10 codes.
- Dedicated Accounts Receivable (AR): Perform daily AR follow-ups with commercial and government payers (Medicare/Medicaid) to resolve unpaid, short-paid, or aging claims.
- Prior Authorizations & Verifications: Verify insurance coverage and obtain/track prior authorizations (PAs) for specialty infusion medications to prevent treatment delays and claim rejections.
- Denial Management & Appeals: Analyze EOBs/ERAs to identify root causes of denials (medical necessity, authorization, modifier errors) and draft formal appeals with supporting clinical documentation.
- Payer & EHR Operations: Navigate major payer portals (Availity, Noridian, UHC, Cigna) and maintain accurate documentation within EHR/billing systems (EPIC, Athena, OncoEMR, etc.).
What We Are Looking For:
- Experience: 3+ years in U.S. Medical Billing and AR, with hands-on experience in Oncology, Hematology, or Specialty Infusion Billing.
- Drug Billing Expertise: Strong working knowledge of J-Codes, HCPCS Level II, drug units, and payer-specific infusion reimbursement policies.
- RCM Mastery: Proven track record in prior authorization tracking, end-to-end claims submission, and denial resolution.
- EHR Systems: Proficiency in top-tier EHR/EMR and clearinghouse systems (e.g., EPIC, Athenahealth, Waystar).
- Communication: Excellent verbal and written English communication skills for professional payer and internal team coordination.
Position Details:
- Work Location: 100% Remote (Philippines)
- Schedule: Full-Time | Night Shift (U.S. Business Hours)
- Equipment Requirement: Must have a dedicated home office setup with high-speed internet.
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