Medical Billing Specialist

Job Description:

We are seeking a detail-oriented and knowledgeable Medical Biller and Coder with specialized experience in biologic medications to join our growing team. IN PERSON ONLY NOT A REMOTE POSITION This position is crucial for ensuring accurate coding, billing, and reimbursement for high-cost biologics across multiple specialties, including rheumatology, oncology, dermatology, and gastroenterology. IN HOUSE BILLER ONLY MUST BE IN NJ

The ideal candidate will be experienced in insurance verification, biologic drug coding, and compliance with payer-specific requirements.

Key Responsibilities: Clinical Documentation Review

• Review medical records to confirm documentation supports:
• Medical necessity for biologic therapy
• Dosage, frequency, and prior treatment failure

Medical Coding

• Accurately assign:
• ICD-10-CM diagnosis codes
• CPT/HCPCS codes for drug administration and infusions
• HCPCS Level II or NDC drug codes (e.g., J-codes)
• Apply modifiers appropriately (e.g., -JW for wastage)

Insurance Verification & Benefits Coordination

• Verify patient insurance for biologic coverage
• Identify requirements such as:
• Step therapy
• Specialty pharmacy usage
• Prior authorization (PA)

Billing and Charge Entry

• Input biologic drug charges based on correct units and drug strength
• Apply proper wastage documentation and modifiers
• Submit clean claims with attention to detail

Claims Management

• Track claims to ensure timely reimbursement
• Resolve denials and underpayments related to biologic billing
• Submit appeals with supporting clinical documentation

Compliance and Audit Preparation

• Ensure coding and billing practices align with payer rules, CMS guidelines, and HIPAA regulations
• Maintain audit-ready records and documentation

Qualifications:

• 2 years of experience in medical billing and coding (biologic drug experience strongly preferred)
• CPC, CCS, or equivalent medical coding certification preferred
• Experience with J-codes, biologics, or specialty medications required
• Proficient with EHR and billing systems (e-cinical,R2 WEinfuse)
• Strong knowledge of payer guidelines, PA processes, and appeals
• Excellent attention to detail and organizational skills

Preferred Experience:

• Familiarity with billing for drugs such as Humira, Remicade, Simponi aria, Kyrstexxa, Enbrel,Cosentyx,
• Previous work in a rheumatology, oncology, gastroenterology, or dermatology setting

Benefits:

• Competitive salary based on experience
• Health, dental, vision insurance
• PTO, paid holidays
• 401(k)

Job Type: Full-time

Pay: From $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Flexible schedule
• Flexible spending account
• Paid time off

Education:

• High school or equivalent (Required)

Experience:

• infusion billing : 2 years (Preferred)
• Medical billing: 3 years (Required)

Location:

• West Long Branch, NJ 07764 (Preferred)

Ability to Commute:

• West Long Branch, NJ 07764 (Preferred)

Work Location: In person

Salary : $23