Infusion Authorization & Billing Specialist

JOB DESCRIPTION

Job Title:

Infusion Authorization & Billing Specialist

Position Summary

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.

Reporting Structure

• Reports to:
  
  Team Leader/Supervisor
• May provide guidance or oversight to volunteers as assigned

Key Responsibilities

Revenue Cycle & Billing Operations

• 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

Pre-Authorization & Patient Access Management

• 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

Compliance & Quality

• 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

Customer Service & Collaboration

• 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

Education

• High school diploma required
• Coding Certification and/or Certified Medical Assistant (CMA) preferred

Experience

• Minimum of one year of healthcare or medical office experience preferred
• Working knowledge of medical terminology, insurance processes, and revenue cycle workflows

Technical Skills

• 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

Knowledge, Skills, and Abilities

• 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

Physical & Environmental Requirements

• Frequent sitting and computer use
• Occasional standing, lifting, carrying, pushing, or pulling up to 25 lbs; infrequent lifting up to 50-75 lbs
• Occasional stooping, crouching, kneeling, and reaching
• Category III exposure to blood borne pathogens
• Minimal exposure to chemical hazards

Professional Characteristics

• 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.