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

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

RCM Operations Specialist, Infusion (AI Platform)

Responsibilities

Qualification

Required

Preferred

Company

Runtrellis

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