Infusion Authorization & Billing Specialist

Infusion Authorization & Billing Specialist The Infusion Authorization & Billing Specialist supports infusion services by managing pre-authorizations, charge entry, reporting, and the complete revenue cycle from authorization through claim resolution, in accordance with payer and regulatory requirements. This role plays a critical part in ensuring accurate billing, regulatory compliance, timely reimbursement, and a positive patient financial experience while supporting clinical operations. Reports to: Team Leader/Supervisor May provide guidance or oversight to volunteers as assigned Key responsibilities include: Enter, review, and maintain accurate charge data in accordance with current CPT, HCPCS, and payer-specific coding guidelines Post payments, adjustments, and account notes accurately within billing and medical record systems Generate and analyze departmental reports to support operational and financial performance Collaborate with coding, billing, and clinical teams to resolve discrepancies and ensure clean claims Identify and correct charge or posting errors in a timely and compliant manner Obtain and track required pre-authorizations for biologic medication services Verify insurance coverage and eligibility on a daily basis Monitor patient schedules to ensure authorizations, documentation, and required testing are complete Communicate authorization approvals, denials, and delays clearly within electronic medical records and billing systems Initiate and manage authorization appeals in accordance with payer and regulatory requirements Support scheduling coordination and proactively address authorization-related barriers to care Ensure all activities comply with HIPAA, CMS regulations, payer policies, and organizational standards Maintain strict confidentiality of patient and organizational information Support audits, quality initiatives, and continuous process improvement efforts Apply sound judgment and problem-solving skills to resolve issues and prevent recurrence Provide professional, respectful, and patient-centered communication at all times Handle sensitive or complex patient financial conversations with empathy and clarity Promote teamwork, collaboration, and a positive work environment across departments Required qualifications include: High school diploma required Coding Certification and/or Certified Medical Assistant (CMA) preferred Minimum of one year of healthcare or medical office experience preferred Working knowledge of medical terminology, insurance processes, and revenue cycle workflows Proficiency with electronic medical records (EMR), billing systems, and claims management software Strong computer skills, including Excel and other Microsoft Office applications Accurate typing and data entry skills, including ten-key Strong written and verbal communication skills Ability to work independently, prioritize tasks, and meet deadlines High attention to detail and accuracy Effective problem-solving and critical-thinking abilities Ability to adapt in a fast-paced, regulated healthcare environment Demonstrated commitment to compliance, accountability, and ethical standards Frequent sitting and computer use Occasional standing, lifting, carrying, pushing, or pulling up to 25 lbs; infrequent lifting up to 5075 lbs Occasional stooping, crouching, kneeling, and reaching Category III exposure to bloodborne pathogens Minimal exposure to chemical hazards Professional, tactful, and patient-focused demeanor Organized, flexible, and able to function effectively under pressure Receptive to feedback and committed to continuous improvement Demonstrates initiative and ownership of responsibilities Respects and supports diversity, equity, and inclusion Actively supports the mission, values, and philosophy of the organization Disclaimer: This job description reflects the primary responsibilities of the position and is not intended to be all-inclusive. Additional duties may be assigned based on operational needs.

Created: 2026-03-04