Pharmacy Billing Specialist

GeBBS Healthcare Solutions is a leading provider of Revenue Cycle Management (RCM) and Risk Adjustment services, helping healthcare organizations optimize operations, improve financial performance, maintain compliance, and enhance the patient experience. Recognized as a KLAS® Top Performer, GeBBS combines innovative technology, industry expertise, and a commitment to excellence to deliver measurable results for clients across the healthcare industry. We are dedicated to being a trusted healthcare partner by upholding the highest standards of quality, information security, and compliance.

At GeBBS, we foster a collaborative and growth-oriented culture where employees are empowered to develop their skills, advance their careers, and make a meaningful impact in transforming healthcare.

The Billing Specialist is responsible for the timely and accurate preparation, review, and submission of medical and pharmacy claims for assigned clients across Ambulatory Infusion Centers (AIC), Specialty Pharmacy (SP), and Home Infusion services. This role ensures claims are billed in accordance with payer requirements, coding guidelines, contractual obligations, and client-specific workflows to maximize reimbursement and reduce denials.

The Billing Specialist works closely with intake, prior authorization, cash posting, accounts receivable, clinical, pharmacy, and client teams to ensure accurate claim generation and successful reimbursement outcomes.

• Review patient accounts for billing readiness.
• Verify all required documentation, authorizations, and charges are present prior to claim submission.
• Prepare and submit professional, facility, infusion, and pharmacy claims to payers.
• Ensure claims are submitted within payer filing deadlines.
• Review claims for completeness and accuracy before submission.
• Monitor claim transmission reports and resolve claim rejections promptly.

• Bill infusion therapies in accordance with payer-specific guidelines.
• Review and validate HCPCS, J-Codes, CPT codes, ICD-10 diagnosis codes, modifiers, units, and place of service codes.
• Ensure accurate billing of drug administration services, hydration, injections, and infusion procedures.
• Verify infusion documentation supports billed services.
• Monitor payer-specific infusion reimbursement requirements.

• Submit specialty pharmacy claims through applicable pharmacy and medical benefit channels.
• Review claim adjudication responses and identify claim issues.
• Resolve claim rejections and payer edits.
• Coordinate with pharmacy teams regarding prescription, dispensing, and reimbursement requirements.
• Support coordination of benefits activities.

• Review home infusion services for billing accuracy.
• Ensure nursing, drug, supply, and administration services are billed appropriately.
• Verify documentation meets payer requirements.
• Submit home infusion claims in accordance with payer and regulatory guidelines.

• Monitor clearinghouse and payer claim edits.
• Research and correct rejected claims.
• Resubmit corrected claims within established turnaround times.
• Identify recurring billing issues and recommend process improvements.
• Collaborate with intake and authorization teams to prevent future billing delays.

• Verify prior authorizations are obtained and documented appropriately.
• Confirm authorization requirements align with billed services.
• Ensure all required clinical documentation supports claim submission.
• Communicate missing information to appropriate departments for resolution.

• Review charges for accuracy and completeness.
• Identify missing charges or billing opportunities.
• Ensure…