We are looking for an experienced Medical Billing Specialist to support infusion-related billing and authorization activities in Houston, Texas. This Long-term Contract position focuses on insurance verification, prior authorization processing, benefit review, and patient estimate preparation in a fast-paced healthcare setting. The role requires close attention to documentation, clear communication with patients, and strong knowledge of payer guidelines and compliance standards.
Responsibilities:
- Confirm insurance coverage, eligibility, and benefit details for infusion-related services before treatment is scheduled or provided.
- Prepare and submit prior authorization requests with complete clinical and billing documentation to support timely payer review.
- Examine medical records and physician documentation to determine whether submitted information meets payer requirements for infusion services.
- Develop accurate patient cost estimates based on verified benefits, coverage limitations, and expected out-of-pocket responsibility.
- Communicate with patients to explain authorization status, insurance details, and anticipated financial responsibility in a clear and thorough manner.
- Coordinate with internal billing and clinical teams to resolve missing information, follow up on pending approvals, and prevent delays in service.
- Maintain accurate records of benefit verification, authorization activity, and patient communication while following HIPAA and PHI standards.
- Review payer responses and update account information to ensure billing workflows reflect the latest authorization and coverage outcomes.
- Previous experience in medical billing, insurance verification, or authorization support within a healthcare environment.
- Working knowledge of infusion service billing processes and payer requirements for pre-service approval.
- Ability to read and interpret clinical documentation and apply it to authorization and billing needs.
- Familiarity with HIPAA, PHI handling, and other healthcare compliance expectations.
- Strong understanding of insurance benefits, coverage rules, and patient financial responsibility calculations.
- Effective verbal and written communication skills for interacting with patients and internal teams.
- High level of accuracy, organization, and follow-through when managing documentation and multiple open cases.