Job Openings Medical Biller

About the job Medical Biller

Medical Biller

Rheumatology | Full-Time | 40 Hours/Week | CST

Job Description: Virtual Benefits Coordinator – Infusion Services

Position Summary

The Virtual Benefits Coordinator is responsible for obtaining and documenting insurance eligibility and benefits for patients receiving infusion therapy. This position plays a critical role in ensuring accurate insurance verification, identifying coverage requirements, and supporting timely patient care by maintaining complete and up-to-date benefit information within the practice's systems.

The Virtual Benefits Coordinator works primarily within the WeInfuse platform, prioritizing the verification queue, and collaborates closely with the infusion, billing, and clinical teams to ensure seamless communication regarding patient insurance coverage and authorization requirements.

This position is co-managed by the Billing Manager and the Infusion Manager.

Essential Duties and Responsibilities

Insurance Verification

  • Verify patient insurance eligibility and benefits for infusion services.

  • Contact commercial insurance companies, Medicare, Medicaid, and other payers to obtain accurate benefit information.

  • Utilize insurance carrier portals and payer websites to verify eligibility and benefits whenever available.

  • Determine coverage for both:

    • Infusion drug (J-code or applicable HCPCS code)

    • Drug administration (CPT administration code)

  • Identify and document payer requirements including:

    • Prior Authorization

    • Medical Necessity requirements

    • Pre-determination

    • Referral requirements

    • Coverage limitations

    • Deductibles, coinsurance, copays, and out-of-pocket responsibilities

Documentation

  • Maintain accurate and detailed documentation within the WeInfuse platform.

  • Complete all required verification fields manually and update each patient's verification status.

  • Prioritize and manage the WeInfuse Verification Queue to ensure timely completion of insurance verifications.

  • Document detailed notes regarding insurance conversations, reference numbers, representative names, and benefit information.

  • Enter and maintain insurance information within eClinicalWorks (eCW).

  • Update patient insurance information in eCW when new or changed coverage is identified.

Patient Communication

  • Contact patients when clarification regarding insurance coverage is needed.

  • Obtain updated insurance information from patients as necessary.

  • Communicate patient financial responsibility when directed by practice policies.

  • Maintain professional and courteous communication with patients at all times.

Team Collaboration

  • Communicate benefit verification findings promptly with:

    • Infusion Nurses

    • Billing Department

    • Billing Manager

    • Infusion Manager

    • Other Benefits Coordinators

    • Additional infusion staff as needed

  • Escalate insurance concerns or coverage issues to appropriate leadership.

  • Collaborate with the billing and infusion teams to resolve insurance-related issues that may impact scheduling or treatment.

System Management

  • Maintain proficiency in:

    • WeInfuse

    • eClinicalWorks (eCW)

    • Insurance carrier portals

    • Medicare and commercial payer websites

  • Ensure all documentation is accurate, complete, and entered in a timely manner.

  • Follow HIPAA guidelines and maintain patient confidentiality at all times.

Qualifications

Required

  • High school diploma or equivalent.

  • Minimum of one year of medical insurance verification, benefits coordination, or medical billing experience.

  • Experience verifying medical insurance benefits.

  • Strong understanding of medical terminology.

  • Experience working with electronic medical records (EMR).

  • Excellent written and verbal communication skills.

  • Strong organizational and time management skills.

  • Ability to prioritize multiple tasks in a fast-paced environment.

  • Attention to detail and high level of accuracy.

Preferred

  • Experience with infusion therapy benefit verification.

  • Experience using WeInfuse.

  • Experience using eClinicalWorks (eCW).

  • Knowledge of HCPCS (J-codes) and CPT administration codes.

  • Experience with prior authorizations and payer medical policies.

Core Competencies

  • Insurance verification expertise

  • Critical thinking and problem-solving

  • Excellent documentation skills

  • Effective communication

  • Team collaboration

  • Time management

  • Attention to detail

  • Customer service

  • Confidentiality and professionalism

Reporting Structure

Co-Managed By:

  • Billing Manager

  • Infusion Manager

Work Environment

  • Remote/Virtual position.

  • Extensive computer and telephone use throughout the workday.

  • Regular interaction with insurance companies, patients, providers, and internal staff.

  • Must maintain a secure and HIPAA-compliant remote work environment.

Performance Expectations

Success in this role is measured by:

  • Timely completion of insurance verifications.

  • Accuracy of benefit documentation.

  • Effective prioritization of the WeInfuse verification queue.

  • Accurate maintenance of insurance information within eCW.

  • Clear and timely communication with infusion and billing teams.

  • Reduction in treatment delays related to insurance verification.

  • Compliance with practice policies, payer requirements, and HIPAA regulations.




Or refer someone