<p>We’re seeking an experienced <strong>Infusion Billing and Denials Specialist</strong> to join a growing healthcare organization. This role will play a key part in stabilizing and improving the infusion billing process, managing claim denials, and supporting the transition to an in-house billing model. The ideal candidate brings strong technical expertise, a proactive approach to problem-solving, and experience with healthcare billing systems used in infusion or specialty pharmacy settings.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Review, prioritize, and resolve claim denials based on type, urgency, and payer requirements.</li><li>Collaborate with internal teams and third-party vendors to ensure accurate and timely claim submissions.</li><li>Research and resolve billing discrepancies, including coordination with clinical staff for complex or clinical-related denials.</li><li>Track, document, and report denial trends to support process improvement and revenue optimization.</li><li>Assist with billing audits and provide insight on compliance, documentation, and coding accuracy.</li><li>Support the ongoing transition from outsourced billing to an internal model by identifying workflow gaps and recommending improvements.</li><li>Utilize analytics and clearinghouse data to identify patterns in claim rejections and reimbursement delays.</li></ul><p><br></p><p><strong>Systems & Tools</strong></p><p>Experience in the following systems is highly preferred:</p><ul><li><strong>CareTend</strong> (patient accounting)</li><li><strong>eClinicalWorks (ECW)</strong> (clinical documentation)</li><li><strong>Waystar</strong> (clearinghouse)</li><li><strong>PMD</strong> (inpatient billing)</li></ul><p><br></p><p><br></p>

<p><strong>Qualifications</strong></p><ul><li>Must have 3+ years of healthcare billing or denials management experience, within infusion or specialty pharmacy settings.</li><li>Prior hands-on experience with <strong>CareTend</strong> and/or <strong>eClinicalWorks (ECW)</strong> strongly preferred.</li><li>Working knowledge of <strong>Medicare, Medicaid, and commercial payer guidelines</strong>.</li><li>Excellent analytical skills with the ability to identify and correct root causes of denials.</li><li>Strong communication and collaboration skills across clinical and administrative teams.</li><li>No clinical license required; however, experience working alongside RNs/LVNs or clinical appeals teams is beneficial.</li></ul><p><br></p><p><strong>Future Growth</strong></p><p>As processes stabilize, this position may evolve into a <strong>leadership or infusion billing manager role</strong>, providing dedicated oversight to billing operations and supporting continued growth.</p>

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