RCM Operations Specialist, Infusion (AI Platform)
About the role
Role focused on infusion prior authorization and reimbursement within Trellis AI's AI platform. You will review real cases, validate system outputs, create rules and test cases, and collaborate with product and engineering to improve reimbursement processes for infusion and specialty pharmacy providers.
Responsibilities
- Review prior authorization and reimbursement cases for infusion customers, covering benefits, coverage, PA requirements, medical necessity, billing codes and units
- Check each decision against payer policies, Medicare LCDs and NCDs, payer portals and the patient's clinical documentation
- Build answer keys that record the correct outcome for real cases, with the reasoning and source behind each call
- Find patterns in errors and write them up clearly for product and engineering, with examples
- Keep a working library of payer rules, drug coverage criteria and billing conventions up to date
- Learn how customer intake and reimbursement staff handle edge cases, and bring those conventions into the product
- Review early output during customer onboarding and flag risk before it reaches a claim
Qualifications
- 3+ years in infusion or specialty pharmacy revenue cycle, such as prior authorization, benefits verification, billing, denials or appeals
- Working knowledge of medical versus pharmacy benefit, buy and bill, HCPCS J codes, administration CPT codes, NDC to billing unit conversion and modifiers
- Comfort reading LCDs, NCDs and commercial medical policies and applying them to a specific patient
- Experience with payer portals and PA tools such as Availity or CoverMyMeds, and pharmacy or infusion systems such as CPR+ or WellSky
- Careful judgment. You know the difference between what the chart says and what someone assumed
- Clear writing. You can explain a denial risk in two sentences to someone who has never billed a claim
Skills
Benefits
- Will sponsor visa
About Trellis AI
AI for streamlining healthcare paperwork
Trellis helps healthcare providers treat more patients, faster—while eliminating pre-service paperwork. We automate document intake, prior authorizations, and appeals at scale to streamline operations and accelerate care. Our AI agent is trained on millions of clinical data points and converts messy, unstructured documents into clean, structured data directly in your EHR. With Trellis, leading healthcare providers and pharmaceutical companies were able to: 1. Reduce time to treatment by over 90% 2. Improve prior authorization approval and reimbursement rates 3. Leverage structured data to enhance drug program performance and clinical decision-making Administrative costs account for over 20% of U.S. healthcare spending—delaying care, draining revenue, and driving staff burnout while having less visibility into patient care than ever before. We built Trellis to tackle this head on.
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