Team Lead Infusion Billing – Rheumatology

We are looking for a highly skilled Senior Infusion Billing & Revenue Cycle Management (RCM) Specialist with extensive experience in specialty infusion billing, particularly within rheumatology, biologic injections, and infusion procedures. This role requires a deep understanding of the entire financial and administrative lifecycle of infusion therapy, including eligibility verification, prior authorization, coding, claim submission, payment posting, denial management, and accounts receivable recovery. The ideal candidate will be proactive in building and maintaining robust systems for infusion billing, prior authorization, coding, and AR management, while effectively identifying revenue leakage and preventing avoidable denials. This position is based in Lahore, Pakistan, with remote working flexibility.

Key Responsibilities

- Take full ownership of prior authorizations for biologic infusions, specialty medications, and chemotherapy-related treatments, ensuring all authorizations are obtained before treatment and remain valid throughout the treatment cycle.
- Verify medical benefits, coverage, authorization requirements, and payer-specific policies, tracking expiration dates, approved units, treatment frequency, and remaining visits.
- Manage billing for complex rheumatology infusion and injection services, ensuring accurate coding of drug HCPCS/J-codes, units, dosage, administration codes, wastage, infusion time, injection services, diagnosis/ICD-10 codes, and related procedures.
- Review claims thoroughly before submission to ensure correct linkage between drug, dosage, administration, and diagnosis, identifying and correcting coding or billing errors that could lead to denials or underpayments.
- Build and maintain a strong accounts receivable management system focused on infusion and specialty drug claims, prioritizing follow-up based on claim age, value, payer, and denial reasons.
- Conduct aggressive insurance follow-ups, analyze denials to identify root causes, and develop corrective workflows to prevent recurring issues.
- Develop and implement standard operating procedures (SOPs) and foolproof workflows for all aspects of infusion billing, prior authorization, eligibility, coding, claims, payment posting, denials, and AR.
- Conduct regular audits of infusion claims and billing processes to identify revenue leakage and improve collections.
- Coordinate closely with providers, infusion nurses, medical assistants, schedulers, and management to continuously improve workflows, reduce errors, and prevent treatment or billing delays.
- Maintain comprehensive tracking systems for authorization status, treatment schedules, drug units, claims, denials, AR, reimbursements, and outstanding balances.
- Handle authorization denials, reconsiderations, peer-to-peer requirements, and appeals effectively.
- Utilize software tools, especially Tebra, to develop and maintain billing and AR reports, analyze data trends, and implement electronic workflows and automation.

Required Qualifications

- Minimum 4–5 years of hands-on U.S. medical billing and RCM experience, with strong direct experience in infusion billing.
- Demonstrated expertise in rheumatology, biologics, specialty medications, injections, and infusion services.
- Extensive experience managing prior authorizations for biologic infusions and specialty medications.
- Strong knowledge of infusion coding, including HCPCS/J-codes, administration codes, units, wastage, and ICD-10 coding.
- Proven skills in accounts receivable and denial management.
- Required experience with Tebra billing software and Buy-and-Bill reimbursement workflows.
- Excellent spoken and written English communication skills.
- Strong analytical, problem-solving abilities, and high attention to detail.
- Ability to independently identify problems and build effective systems rather than merely performing assigned billing tasks.

Preferred Qualifications and Benefits

- Experience in rheumatology practice billing, infusion center billing, biologic infusion and injection billing, oncology/chemotherapy billing, and specialty pharmacy coordination.
- Familiarity with complex prior authorizations, appeals, Medicare, and commercial payer processes.
- Professional certifications such as CPC, CPB, or equivalent.
- Experience managing remote billing teams and developing RCM SOPs, quality assurance systems, and performance dashboards.
- Salary is negotiable based on experience and qualifications, with a monthly range of Rs200,000 to Rs250,000.
- Benefits include 12 paid PTO days annually, long-term growth opportunities, performance-based advancement, and direct involvement in optimizing infusion and RCM operations.

This is a senior-level position requiring substantial hands-on experience in U.S. infusion billing, biologic prior authorization, specialty medication billing, and infusion AR/denial management. Candidates without this expertise will not be considered. The role demands ownership of the entire financial and administrative infrastructure surrounding the infusion program, ensuring smooth eligibility verification, prior authorization, treatment approval, coding, claim submission, payment, denial management, AR recovery, and revenue optimization.