Home Infusion Medical Biller (Specialty Pharmacy)

About Us:

Vive Rx Pharmacy is a fast-growing home infusion pharmacy specializing in high-cost specialty therapies including IVIG, biologics, antibiotics, and TPN.

We are building a high-performance, automation-driven revenue cycle within the CareTend ecosystem—focused on reducing manual work, improving accuracy, and accelerating collections.

Position Overview:

We are seeking a Home Infusion Biller who can both execute at a high level and think in systems.

This role is a hybrid between:

• A hands-on biller managing claims, follow-ups, and appeals
• A process builder helping refine automation, workflows, and billing logic

You will play a key role in both day-to-day billing operations and building a scalable billing infrastructure.

What Makes This Role Unique:

• Work inside an evolving CareTend automation ecosystem,

including: Per diem kit billing rules tied to therapy types

• Automated unit calculations based on frequency (e.g., 3x/week, 14-day cycles)
• Structured billing templates for repeat therapies
• Exposure to data tracking and performance dashboards (Looker / Google Sheets)
• Opportunity to improve systems, not just follow them
• Direct impact on reducing denials and increasing collections

Key Responsibilities: Billing Execution

• Submit and manage claims for home infusion therapies (IVIG, hydration, antibiotics, TPN, etc.)
• Work with HCPCS coding (J-codes, S-codes, per diems, 99601/99602)
• Review and validate units, NDCs, and billing structure
• Monitor claim status through clearinghouses and payer portals (Availity, etc.)
• Follow up on denials, rejections, and underpayments
• Prepare and submit appeals with supporting documentation

Systems & Process Optimization

• Validate and refine automated billing logic within CareTend
• Identify inefficiencies in workflows and propose improvements
• Assist in building: Billing rules and templates
• Standardized claim workflows
• Quality control checkpoints before claim submission
• Collaborate with intake, pharmacy, and nursing to improve clean claim rate upstream

Required Qualifications:

• 2+ years of home infusion or specialty pharmacy billing experience (REQUIRED)
• Strong understanding of: J-codes and S-codes
• Per diem billing structures
• Infusion therapy workflows
• Experience with claim follow-up, denials, and appeals
• Ability to audit claims and catch errors before submission
• Comfortable working in a structured, process-driven environment

Preferred Qualifications:

• Experience with CareTend or WellSky CPR+
• Experience billing: IVIG, TPN, hydration, biologics
• Familiarity with: Automated billing rules or templated workflows
• Reporting tools (Excel, Google Sheets, Looker)
• Experience with out-of-network billing and repricing (Zelis, Multiplan)

What Success Looks Like:

• Claims submitted accurately within 14 days of date of service
• Reduction in denials and rework
• Increased collections and faster payment turnaround
• Meaningful contributions to automation and workflow improvements
• Ability to spot patterns and fix root causes—not just symptoms

Pay: $25.52 - $30.73 per hour

Expected hours: 80.0 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Experience:

• Medical billing: 1 year (Preferred)
• Home infusion billing: 1 year (Preferred)

Work Location: In person