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...