СШАRCM Operations Specialist, Infusion (AI Platform)
3 нед. назад
от 90k USD / годСШАRemote
medical codingprior authorizationpayer policy analysis
Specialist role focused on reviewing and validating infusion prior authorization and reimbursement cases to ensure accuracy and improve AI platform performance.
О компании
- Trellis builds AI that handles intake, benefits, prior authorization and reimbursement for infusion and specialty pharmacy providers, so patients start therapy faster and providers get paid for it.
Обязанности
- You will be our expert on infusion prior authorization and reimbursement. Our system reads referrals, clinical notes and payer policies, then prepares the work that intake and reimbursement teams do by hand today. Your job is to make sure that work is right. You will review real cases across our customers, catch what the system gets wrong and explain why. Then you turn that judgment into rules and test cases our engineers build on. You will work directly with the product and engineering team.
- Review prior authorization and reimbursement cases for infusion customers, covering benefits, coverage, PA requirements, medical necessity, billing codes and units
- Check each decision against payer policies, Medicare LCDs and NCDs, payer portals and the patient's clinical documentation
- Build answer keys that record the correct outcome for real cases, with the reasoning and source behind each call
- Find patterns in errors and write them up clearly for product and engineering, with examples
- Keep a working library of payer rules, drug coverage criteria and billing conventions up to date
- Learn how customer intake and reimbursement staff handle edge cases, and bring those conventions into the product
- Review early output during customer onboarding and flag risk before it reaches a claim
Требования
- 3+ years in infusion or specialty pharmacy revenue cycle, such as prior authorization, benefits verification, billing, denials or appeals
- Working knowledge of medical versus pharmacy benefit, buy and bill, HCPCS J codes, administration CPT codes, NDC to billing unit conversion and modifiers
- Comfort reading LCDs, NCDs and commercial medical policies and applying them to a specific patient
- Experience with payer portals and PA tools such as Availity or CoverMyMeds, and pharmacy or infusion systems such as CPR+ or WellSky
- Careful judgment. You know the difference between what the chart says and what someone assumed
- Clear writing. You can explain a denial risk in two sentences to someone who has never billed a claim
Будет плюсом
- A CPC, CPB, CRCS or similar certification, or a pharmacy technician or nursing background
- Experience at a home infusion provider, ambulatory infusion center or specialty pharmacy
- Experience with biologics, IVIG and other high cost therapies across Medicare, Medicaid and commercial plans
- Curiosity about how AI can change healthcare operations. No coding required