Job Description
Key Responsibilities
- Review diagnosis and medication coding for infusion services, particularly when payer restrictions are identified.
- Evaluate payer medical policies and CMS guidelines to determine medical necessity and coverage.
- Ensure accurate alignment between clinical documentation and billing codes prior to service delivery.
- Coordinate and validate completion of Advance Beneficiary Notices (ABNs) in the system, including appropriate modifiers.
- Apply knowledge of Medicare guidelines and FDA label coverage to coding decisions.
- Collaborate with infusion intake, billing, and clinical teams to resolve coding discrepancies.
- Identify and escalate complex reimbursement or compliance issues as needed.
- Maintain accurate documentation to support coding decisions and audit readiness.
- Support compliance with regulatory, payer, and organizational billing policies.
- Participate in process impr...