Reimbursement Coordinator - Home Infusion

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� Description

• • Own the full-cycle revenue cycle for home-infusion patients, from intake of clinical documentation through final payment resolution, ensuring every claim is filed clean, tracked, and collected within payer-specific timely-filing windows.
• • Generate and QA 100% of claims before submission, scrubbing charges for HCPCS, CPT, ICD-10, and NDC accuracy, correcting modifiers, units, and diagnosis pointers so denials never leave the building.
• • Submit electronic and paper claims to Medicare, Medicaid, commercial, and specialty payers; prepare secondary claims that do not auto-crossover; and log every transaction in the practice-management system for full audit visibility.
• • Leverage aging, denial, and exception reports to prioritize daily work queues; call IVR portals, payer reps, and clearinghouses to verify claim status and document next steps in under 48 hours.
• • Investigate partial payments, over-payments, and zero-pay remits; post contractual adjustments, secondary payments, and patient responsibility balances with precision to keep AR aging under 45 days.
• • Drive appeals for denied or underpaid claims—pull clinical notes, draft redetermination letters, and attach supporting medical records—achieving a 90%+ overturn rate on high-dollar infusions.
• • Collect patient balances through outbound calls, payment-plan negotiations, and charity-care screening while maintaining compassionate, HIPAA-compliant communication.
• • Identify bad-debt accounts, prepare write-off forms with detailed rationale, and present recommendations to leadership for approval, protecting the organization’s financial integrity.
• • Partner with intake nurses, pharmacists, and branch managers to resolve missing prior authorizations, eligibility mismatches, and coordination-of-benefits issues before they become denials.
• • Contribute to month-end close by reconciling cash deposits, updating denial reason codes, and producing KPI dashboards that highlight trends in payer behavior and process gaps.
• • Champion continuous improvement: propose system enhancements, test new clearinghouse edits, and train teammates on updated payer rules so the entire team scales faster than claim volume.
• • Maintain strict adherence to WellSky security policies, safeguarding PHI and proprietary data while working 100% remote with dual-monitor, VPN-protected workstations.
• • Sit/stand and view computer screens for extended periods, toggling between billing software, payer portals, and Excel trackers with speed and accuracy.
• • Work flexible hours—including early mornings or occasional evenings—during month-end, audit season, or payer deadline crunches to ensure nothing falls through the cracks.
• • Represent WellSky’s mission of intelligent, coordinated care by delivering a seamless financial experience that lets clinicians focus on healing and patients focus on recovery.