Experience 3–6 yrs (3+ years)
About the role
structured by ORITrellis AIAccelerate Medication Access with AIRCM Operations Specialist, Infusion (AI Platform)$65 - $90K•San Francisco, CA, US / Remote (US)Job typeFull-timeRoleOperationsExperience3+ yearsVisaWill sponsorApply to Trellis AI and hundreds of other fast-growing YC startups with a single profile.Apply to role ›About…
What you will do
- 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
What they are looking for
- 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
Nice to have
- 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
Before you apply
- Location restricted to US / Remote (US)
prior authorizationbenefits verificationbillingdenialsappealsbuy and billmedical policyrevenue cycleAvailityCoverMyMedsCPR+WellSky
Full posting text
Experience: 3+ years