Claims Coordinator Specialist

- Assess payer medical policies and CMS guidelines to confirm medical necessity and coverage eligibility.

- Ensure clinical documentation aligns correctly with billing codes prior to service delivery.

- Coordinate and verify the completion of Advance Beneficiary Notices (ABNs) in the system, including correct use of modifiers.

- Apply Medicare guidelines and FDA labeling requirements when making coding determinations.

- Work closely with infusion intake, billing, and clinical teams to resolve coding inconsistencies.

- Identify and escalate complex reimbursement or compliance issues when necessary.

- Mainta...