Claims Reimbursement Specialist (Payer Relations)

BHI helps you manage your TDD patients. And your practice.

Today’s targeted drug delivery and infusion needs require confident coordination among physicians, provider staff, and patients. BHI helps connect all three to allow doctors to extend care beyond the office, provider staff to centralize management for greater efficiency, and patients to receive TDD right in their own home with experienced nurses. BHI helps bring physicians, provider staff, and patients together for Better Home Infusion.

BHI is looking for a Claims Reimbursement Specialist (Payer Relations) who will work closely with the Director of Revenue Cycle Management to support the financial performance of the home infusion business. This role is responsible for reviewing and validating detailed claims spreadsheets prepared by the billing and follow-up teams, ensuring accuracy, compliance, and payer-specific requirements prior to submission or escalation. The Claims Reimbursement Specialist will also serve as a key liaison with payer representatives to assist with claim issue resolution, denial escalation, and ongoing communication related to reimbursement challenges. 

This position requires strong analytical skills, attention to detail, and a solid understanding of home infusion billing, payer policies, and reimbursement workflows. 

This is an in-office, Monday-Friday position.

Key Responsibilities 

• Review detailed claims spreadsheets and supporting documentation for accuracy, completeness, and compliance with payer and contract requirements. 

• Validate coding, modifiers, units, NDCs, authorization details, and billing logic prior to submission or appeal. 

• Identify trends, errors, or process gaps contributing to denials or delayed reimbursement and escalate findings to the Director of Revenue Cycle Management. 

• Assist with the preparation and review of appeal packets, reconsiderations, and formal dispute submissions. 

• Communicate directly with payer representatives to escalate denials, resolve complex claim issues, and clarify payer-specific billing or policy requirements. 

• Track payer responses, follow-up outcomes, and resolution status for escalated claims. 

• Collaborate with billing, follow-up, clinical, and intake teams to resolve discrepancies impacting claims accuracy or payment. 

• Support contract interpretation and application as it relates to reimbursement, billing methodology, and denial prevention. 

• Maintain documentation of payer communications, escalation outcomes, and process updates. 

• Assist with special projects, audits, and data analysis as assigned by the Director of Revenue Cycle Management. 

Required Qualifications 

• Associate or Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field, or equivalent work experience. 

• Minimum of 3–5 years of experience in revenue cycle, billing, or reimbursement, preferably within home infusion, specialty pharmacy, or home health. 

• Strong working knowledge of medical and pharmacy billing concepts, including HCPCS codes, CPT codes, modifiers, NDCs, and payer authorization requirements. 

• Experience reviewing claims data, spreadsheets, and detailed reports with a high level of accuracy. 

• Familiarity with payer portals, remittance advice, and denial codes. 

• Ability to communicate professionally and effectively with payer representatives and internal stakeholders. 

• Strong analytical, organizational, and problem-solving skills. 

• Proficiency in Microsoft Excel and other Microsoft Office applications. 

Preferred Qualifications 

• Experience with home infusion reimbursement models and payer-specific billing nuances. 

• Knowledge of Medicare, Medicaid, and commercial payer policies related to home infusion services. 

• Experience with claim appeals, denial management, and payer escalation processes. 

• Familiarity with revenue cycle management systems and reporting tools. 

At Basic Home Infusion, we are deeply committed to promoting diversity, equity, and inclusion in our provision of intrathecal infusion pain management services. We recognize that these core values are essential for achieving optimal patient outcomes and creating a supportive and inclusive environment for our team members.