Job Description
Responsibilities:
- Review and validate diagnosis and medication coding for infusion services, with a focus on payer-specific requirements and restrictions, serving as the primary resource for complex or non-standard cases.- Analyze payer medical policies and CMS guidelines to determine coverage eligibility and medical necessity, providing expert interpretation in ambiguous or evolving policy situations.- Ensure clinical documentation is accurately aligned with billing and coding requirements before services are rendered.- Oversee the completion and validation of Advance Beneficiary Notices (ABNs), ensuring appropriate modifier usage and system documentation.- Apply advanced knowledge of Medicare regulations and FDA-approved indications to support coding decisions, independently addressing exceptions, denials, and off-label coverage scenarios.- Partner with infusion intake, billing, and clinical teams to resolve coding inconsistenc...