Medical Billing Supervisor (Rheumatology & Infusions)

We are looking for a highly skilled Senior Medical Billing / Infusion Revenue Cycle Specialist with extensive hands-on experience in U.S. specialty infusion billing. This role focuses on rheumatology, biologic medications, injections, and complex infusion procedures. The ideal candidate will have comprehensive knowledge 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. This position requires developing and maintaining robust systems for infusion billing, prior authorization, coding, and AR management, while proactively identifying revenue leakage and preventing avoidable denials.

Key Responsibilities
Infusion Prior Authorization & Benefits
Take full ownership of prior authorizations for biologic infusions and specialty medications, including injections and chemotherapy treatments. Verify medical benefits, coverage, authorization requirements, and payer-specific policies. Ensure all necessary authorizations are obtained and remain valid throughout treatment, tracking expiration dates, approved units, treatment frequency, and remaining visits. Establish systems to prevent treatment delays caused by expired or missing authorizations. Identify distinctions between medical-benefit and pharmacy-benefit requirements, including specialty pharmacy carve-outs. Manage authorization denials, reconsiderations, peer-to-peer reviews, and appeals.

Infusion Billing & Coding
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), and related procedures or supplies. Review claims for accuracy before submission, ensuring correct linkage between drug, dosage, administration, and diagnosis. Identify coding and billing errors that may cause denials or underpayments. Maintain a strong understanding of Buy-and-Bill reimbursement workflows.

Accounts Receivable & Denial Management
Build and maintain a strong AR management system for infusion and specialty drug claims. Monitor unpaid claims and prioritize AR based on age, dollar value, payer, and denial reason. Conduct timely and aggressive insurance follow-up. Analyze denials to identify root causes and develop corrective workflows. Manage underpayments, incorrect reimbursements, bundled payments, and payer discrepancies. Maintain clear documentation of all AR follow-up activities. Establish measurable AR KPIs and provide regular reports to management.

Revenue Cycle & Process Development
Develop and implement SOPs and workflows for infusion billing, prior authorization, eligibility, coding, claims, payment posting, denials, and AR. Conduct regular audits of infusion claims and billing processes. Identify revenue leakage and opportunities to improve collections. Establish systems for tracking authorization status, treatment schedules, drug units, claims, denials, AR, reimbursements, and outstanding balances. Collaborate closely with providers, infusion nurses, medical assistants, schedulers, and management. Continuously improve workflows to reduce errors and prevent treatment or billing delays.

Payer & Specialty Knowledge
Demonstrate strong familiarity with U.S. commercial insurance, Medicare, and other health plans involving specialty medications and infusion services. Possess in-depth knowledge of payer requirements for rheumatology biologics and specialty medications.

Software & Reporting
Experience with Tebra billing software is required. Ability to develop and maintain effective billing and AR reports. Strong Excel and data analysis skills to identify trends in denials, reimbursement, AR aging, and payer performance. Experience implementing electronic workflows and automation is preferred.

Required Qualifications
Minimum 4–5 years of hands-on U.S. medical billing and revenue cycle management experience. Strong, direct experience in infusion billing, particularly rheumatology, biologics, specialty medications, injections, and infusion services. Extensive experience with prior authorization for biologic infusions and specialty medications. Strong knowledge of infusion coding, HCPCS/J-codes, administration codes, units, wastage, and ICD-10 coding. Proven AR and denial management expertise. Tebra billing experience is mandatory. Experience with Buy-and-Bill reimbursement models. Excellent spoken and written English communication skills. Strong analytical and problem-solving abilities with high attention to detail. Ability to independently identify problems and build effective systems beyond routine 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. Skilled in managing complex prior authorizations and appeals. Familiarity with Medicare and commercial payer processes. Professional certifications such as CPC, CPB, or equivalent. Experience managing remote billing teams and developing RCM SOPs, QA systems, and performance dashboards. Salary is negotiable based on experience and qualifications. This is a fully remote position offering 12 paid PTO days annually. Long-term growth opportunities with performance-based advancement. Direct involvement in developing and optimizing the practice’s infusion and revenue cycle management operations.

This senior-level role demands substantial hands-on expertise in U.S. infusion billing, biologic prior authorization, specialty medication billing, and infusion AR/denial management. Candidates without this specialized experience will not be considered. The position requires full ownership of the financial and administrative infrastructure supporting the infusion program to maximize revenue and operational efficiency.