House + Home Loans

Revenue Cycle Specialist

• Submit accurate claims for infusion therapies, injectable medications, and physician-administered drugs to insurance payers
• Track claims to ensure timely processing and reimbursement
• Identify and address claim rejections and denials promptly
• Reconcile payments and outstanding balances for infusion and injectable drug claims
• Maintain detailed records of payer communications and payment status
• Confirm insurance eligibility and coverage for infusion therapies and physician-administered drugs
• Collaborate with pharmacy and clinical teams to obtain prior authorizations when required
• Ensure claims comply with payer policies, coding standards, and regulations
• Maintain organized and accurate documentation for audit purposes
• Identify opportunities to optimize the infusion and medical benefit drug billing process

Infusion and Specialty Drug Revenue Cycle Specialist

Accounts Receivable

• Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes.
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up.
• Keep educated on billing and medical policies for all payers.
• Have a working knowledge of In and Out of Network reimbursement processes/methodologies.
• Create and follow up on appeals needed to protest denials or incorrect payments.
• Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary.
• Work across all RCM departments to get issues related to claims payment resolved.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Work with AR Supervisor to review/resolve open accounts as assigned.
• Perform other duties as assigned.

Accounts Receivable Specialist

Analyst

• Responsible for building system components, testing, implementation support, and maintenance of assigned Epic applications.
• Perform in-depth analysis, troubleshooting, data collection, and root cause analysis.
• Work closely with other analysts, Epic third-party vendors, and operations.
• Research, analyze, facilitate and implement business and system workflows.
• Provide third tier support for various applications/modules.
• Serve as a primary resource to the EMR super-users in ticket resolution.

Infusion and Specialty Drug Revenue Cycle Specialist

Accounts Receivable Specialist

Epic Applications Analyst – Professional Billing