Oso Home Care is hiring a full-time Pharmacy Technician. Must have sterile compounding experience. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Irvine, CA, where the 405 and 55 freeways meet.
Hours: Monday to Friday with rotating weekends.
Job Duties:
Sterile compounding.Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is hiring a full-time Pharmacy Technician. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Irvine, CA, where the 405 and 55 freeways meet.
Hours: Monday to Friday with rotating weekends.
Job Duties:
Receive written prescription or refill requests and verify that information is complete and accurate. Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is seeking a Clinical Pharmacist for its Burbank Home Infusion Pharmacy. This is a fantastic opportunity to join a team of talented, enthusiastic healthcare professionals that provide outstanding patient care from a dynamic setting. This position offers Clinical Pharmacists the opportunity to work with Physicians, Nurses, and patients to manage infusion therapies.
Hours: Start time between 9:00 am and 10:00 am (8 hours a day), Monday to Friday, with rotating weekends
Candidates must have:
Registered Pharmacy License.At least 1 year of Home Infusion or Specialty Pharmacy experience.IV Dosing & Sterile Compounding
Prepare and dispense intravenous medications, ensuring proper dosages, sterility, and safety protocols.
Perform aseptic technique for compounding and IV preparation, ensuring compliance with USP standards.
TPN Formulations
Formulate and adjust Total Parenteral Nutrition (TPN) solutions based on individual patient needs, including fluid volume, electrolytes, vitamins, and trace elements.
Vancomycin Monitoring
Monitor Vancomycin therapy, adjusting dosing based on therapeutic drug levels, renal function, and patient response.
Ensure proper blood levels are maintained within therapeutic range to avoid toxicity or suboptimal effects.
Ambulatory Infusion Pump Programming
Program and set up ambulatory infusion pumps for home-based therapy, ensuring proper flow rates, alarm settings, and patient safety.
Provide patient education on pump usage, troubleshooting, and emergency procedures.
Prescription Entry & Verification
Accurately enter and verify prescriptions, ensuring correct dosages, drug interactions, and patient history.
Process an average of 20-25 prescriptions per day, ensuring timely and accurate dispensing.
New Patient Intake & Consultation
Process an average of 7-8 new patient cases per day, assessing their medication needs and history to ensure appropriate therapy.
Provide consultation and patient counseling, ensuring understanding of their medications, treatment plans, and potential side effects.
Delivery Ticket Management
Manage delivery tickets for prescriptions and medical supplies, ensuring timely and accurate fulfillment for home or facility delivery.
Collaboration & Communication
Work closely with healthcare teams, including physicians, nurses, and other pharmacists, to ensure optimal patient care and medication management.
Quality Control & Compliance
Adhere to all pharmacy laws, regulations, and best practices for patient safety and medication accuracy.
Participate in continuous quality improvement efforts, ensuring compliance with state and federal guidelines.
Candidate must have strong phone and communication skills to counsel patients.We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is seeking a detail-oriented, customer-focused, and highly organized Authorization Specialist to join our Specialty Home Infusion Pharmacy team. The Authorization Specialist is responsible for obtaining timely insurance authorizations and ensuring patients receive medically necessary infusion therapies without unnecessary delays.
As a critical member of the Intake Department, the Authorization Specialist serves as the liaison between physicians, hospitals, insurance companies, case managers, specialty pharmacies, nursing staff, and internal departments to facilitate patient access to care. This position works closely with Intake Coordinators, Benefits Verification Specialists, Reimbursement Specialists, Clinical Pharmacists, Nurses, and Sales Representatives to ensure authorizations are obtained accurately, efficiently, and in compliance with payer requirements.
The ideal candidate possesses strong analytical skills, extensive knowledge of commercial and government insurance plans, prior authorization processes, medical necessity guidelines, and infusion therapy reimbursement. This individual must be able to prioritize multiple referrals in a fast-paced healthcare environment while maintaining exceptional customer service and attention to detail.
Essential Duties and ResponsibilitiesPrior Authorization ManagementReview new patient referrals to determine authorization requirements based on payer guidelines and therapy ordered.Submit prior authorization requests to commercial insurance carriers, Medicare Advantage plans, Medicaid Managed Care plans, HMOs, PPOs, IPA groups, and other third-party payers.Prepare and submit complete authorization packages including physician orders, clinical documentation, laboratory results, progress notes, infusion plans, and supporting medical necessity documentation.Ensure authorizations are submitted accurately and within departmental turnaround standards.Monitor authorization status daily and proactively follow up with insurance companies to prevent delays in patient care.Obtain authorization extensions, additional visits, continuation of therapy authorizations, and recertifications as required.Document all authorization activity accurately within the electronic medical record and payer portals.Insurance CoordinationVerify patient eligibility and benefits in collaboration with Benefits Verification Specialists.Interpret insurance coverage guidelines for specialty infusion medications and nursing services.Understand payer-specific authorization requirements for:Commercial insuranceMedicareMedicare AdvantageMedicaidManaged Care OrganizationsWorkers' Compensation (when applicable)Review benefit limitations, authorization requirements, frequency limitations, and medical policies.Communicate insurance requirements to internal departments and referral sources.Clinical Documentation ReviewReview physician orders for completeness and medical necessity.Ensure documentation supports payer requirements prior to submission.Coordinate with physicians' offices to obtain:Signed physician ordersHistory & PhysicalProgress notesLaboratory resultsCulture reportsImaging reportsMedication historyOther required documentationIdentify missing clinical documentation and coordinate timely follow-up.Payer CommunicationDevelop professional working relationships with payer representatives and utilization review nurses.Respond to requests for additional information.Participate in peer-to-peer review coordination when requested by physicians.Escalate complex authorization issues appropriately.Track payer response times and identify trends affecting patient access.Appeals ManagementAssist with first-level and subsequent appeals for denied authorization requests.Gather supporting documentation necessary for appeal submissions.Coordinate with pharmacists, nurses, physicians, and reimbursement staff during appeal processes.Monitor appeal deadlines and ensure timely submissions.Maintain detailed records of appeal outcomes.CollaborationWork closely with:
Intake CoordinatorsBenefits Verification SpecialistsReimbursement SpecialistsBilling DepartmentClinical PharmacistsHome Health NursingAmbulatory Infusion Center (AIC)Physician OfficesHospital Case ManagersSales & Business Development RepresentativesReferral Coordinatorsto ensure patients begin therapy as quickly and efficiently as possible.
Regulatory ComplianceMaintain compliance with:CMS regulationsMedicare guidelinesHIPAA Privacy RulesACHC Accreditation StandardsCalifornia pharmacy regulationsCommercial payer policiesCompany policies and proceduresMaintain patient confidentiality at all times.Participate in quality improvement initiatives and departmental audits.DocumentationMaintain complete and accurate documentation within the electronic medical record.Document:Authorization statusDates submittedAuthorization numbersEffective datesVisit limitationsApproved medicationsApproved nursing visitsCommunication with payersMaintain accurate electronic referral tracking.Customer ServiceProvide exceptional customer service to patients, families, physicians, referral sources, hospitals, and internal departments.Respond promptly to authorization inquiries.Communicate authorization status professionally and accurately.Maintain positive relationships with referral sources through timely communication.Minimum QualificationsHigh School Diploma or equivalent required.Associate's degree in Healthcare Administration, Medical Assisting, Business Administration, or related field preferred.Minimum two (2) years of prior authorization experience in:Specialty PharmacyHome InfusionHome HealthHospital Case ManagementMedical GroupInfusion CenterExperience submitting authorizations to commercial and government payers.Experience utilizing payer portals and electronic authorization systems.Preferred QualificationsHome Infusion experience strongly preferred.Specialty Pharmacy experience preferred.Knowledge of infusion therapies including:IV AntibioticsIVIGBiologic therapiesTPNEnteral NutritionHydrationChemotherapy support medicationsSpecialty injectable medicationsKnowledge of Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).Experience working with CareTend, CPR+, Brightree, EnterpriseRx, or similar healthcare software.Knowledge & SkillsThorough knowledge of prior authorization processes.Strong understanding of medical insurance terminology.Knowledge of:HCPCS CodesCPT CodesICD-10 CodingRevenue Cycle processesMedical necessity guidelinesStrong organizational and time management skills.Ability to prioritize multiple urgent referrals simultaneously.Excellent written and verbal communication skills.Strong critical thinking and problem-solving abilities.Excellent attention to detail.Ability to work independently while functioning effectively within a multidisciplinary healthcare team.Intermediate proficiency with Microsoft Office Suite, Outlook, Excel, and electronic medical records.Core CompetenciesCustomer Service ExcellenceAccountabilityTeamworkCommunicationAttention to DetailCritical ThinkingProblem SolvingTime ManagementOrganizationAdaptabilityRegulatory CompliancePatient AdvocacyProfessionalismPerformance ExpectationsThe Authorization Specialist is expected to consistently:
Meet departmental authorization turnaround standards.Submit complete and accurate authorization requests.Maintain high authorization approval rates.Minimize authorization-related delays in patient care.Maintain documentation accuracy.Demonstrate professionalism in all payer and referral source interactions.Support departmental quality initiatives and continuous process improvement.Maintain compliance with all regulatory, accreditation, and company requirements.Why Join Oso Home Care?Since 1984, Oso Home Care has been a privately owned leader in specialty home infusion and ambulatory infusion services throughout Southern California. We are dedicated to improving patients' lives by delivering high-quality infusion therapy with compassion, clinical excellence, and personalized care.
At Oso Home Care, employees enjoy a collaborative, family-oriented culture with opportunities for professional growth, ongoing education, and meaningful work that directly impacts patient outcomes.
Oso Home Care is proud to be an Equal Opportunity Employer and is committed to creating a diverse and inclusive workplace for all employees.
Read LessOso Home Care is seeking an experienced Sterile Compounding Infusion Pharmacy Technician to join our growing Home Infusion Pharmacy team. This position is responsible for preparing sterile compounded medications for home infusion patients while ensuring strict compliance with USP <797>, USP <800>, California Board of Pharmacy regulations, ACHC accreditation standards, and company policies.
This role requires previous home infusion pharmacy experience and the ability to safely prepare sterile medications in a fast-paced, high-volume environment. The ideal candidate is highly organized, detail-oriented, and committed to delivering exceptional patient care through accuracy, efficiency, and regulatory compliance.
Essential ResponsibilitiesSterile CompoundingPrepare sterile compounded medications using aseptic technique in accordance with USP <797> and USP <800>.Compound a variety of home infusion therapies, including IV antibiotics, hydration therapy, total parenteral nutrition (TPN), IVIG, biologics, chemotherapy, pain management, and other specialty infusion medications.Perform accurate pharmaceutical calculations and prepare medications under the supervision of a licensed pharmacist.Label, package, and stage compounded medications for pharmacist verification.Ensure all compounded preparations meet quality, sterility, stability, and beyond-use dating requirements.Pharmacy OperationsPrepare medications according to daily production schedules while meeting established turnaround times.Assist pharmacists in maintaining an efficient workflow and prioritizing production needs.Package medications for delivery while maintaining proper storage and temperature requirements.Support same-day and STAT medication preparation as needed.Maintain a clean, organized, and compliant sterile compounding environment.Quality & Regulatory ComplianceMaintain compliance with USP <797>, USP <800>, California Board of Pharmacy regulations, ACHC standards, OSHA requirements, HIPAA, and company policies.Follow all aseptic technique, garbing, and cleanroom protocols.Perform routine cleanroom cleaning, disinfecting, and environmental maintenance.Complete batch records, compounding logs, lot number tracking, temperature logs, and quality assurance documentation.Immediately report medication discrepancies, contamination concerns, equipment issues, or quality-related events.Inventory ManagementReceive, inspect, and properly store medications and sterile supplies.Rotate inventory using First Expired, First Out (FEFO) principles.Monitor medication expiration dates and maintain appropriate inventory levels.Assist with inventory counts and ordering of sterile compounding supplies.Required QualificationsCurrent California Pharmacy Technician License.Minimum of two (2) years of recent sterile compounding experience in a Home Infusion Pharmacy.Previous Home Infusion Pharmacy experience is required. Applicants without home infusion pharmacy experience will not be considered.Demonstrated proficiency with USP <797> sterile compounding standards.Working knowledge of USP <800> hazardous drug handling requirements.Experience compounding IV antibiotics, TPN, hydration therapy, IVIG, biologics, pain management medications, chemotherapy, and other specialty infusion therapies.Excellent mathematical, pharmaceutical calculation, and problem-solving skills.Strong organizational skills with exceptional attention to detail.Ability to work independently and collaboratively in a multidisciplinary healthcare environment.Ability to prioritize multiple urgent requests while maintaining a high level of accuracy and quality.Preferred QualificationsPharmacy Technician Certification Board (PTCB) certification.Experience using CPR+, CareTend, QS/1, or other home infusion pharmacy software.Experience working in an ACHC, URAC, or Joint Commission accredited pharmacy.Experience with hazardous sterile compounding.Physical RequirementsAbility to stand for extended periods.Ability to wear required cleanroom PPE and sterile garb for prolonged periods.Ability to lift and carry up to 30 pounds.Manual dexterity necessary for sterile compounding and syringe manipulation.Ability to work in refrigerated medication storage areas when necessary.Why Join Oso Home Care?Founded in 1984, Oso Home Care is a family-owned leader in home infusion and specialty pharmacy services throughout Southern California. We are dedicated to providing exceptional clinical care while fostering a supportive, collaborative workplace where employees are valued and have opportunities for professional growth.
We offer:
Competitive compensationComprehensive medical, dental, and vision benefits401(k) with company matchPaid time off and paid holidaysOngoing training and professional developmentCareer advancement opportunitiesA collaborative and patient-focused cultureIf you are an experienced Home Infusion Sterile Compounding Pharmacy Technician who is passionate about patient care and clinical excellence, we encourage you to apply and become part of the Oso Home Care team.
Oso Home Care is an Equal Opportunity Employer.
Read LessOso Home Care is seeking an experienced Major Medical Collector to join our Billing & Reimbursement Department. Since 1984, Oso Home Care has been a leader in specialty home infusion pharmacy, ambulatory infusion center (AIC), and home health services throughout Southern California.
The Major Medical Collector is responsible for managing complex insurance accounts receivable for specialty home infusion pharmacy, infusion nursing services, ambulatory infusion center (AIC), and home health claims. This position focuses on maximizing reimbursement by aggressively pursuing payment of outstanding claims, researching payment discrepancies, resolving denials, preparing appeals, and ensuring timely collections from Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, Commercial PPO/HMO plans, Workers' Compensation, and other third-party payers.
This role requires an advanced understanding of specialty infusion medications, home infusion billing, pharmacy reimbursement methodologies, medical necessity requirements, prior authorization, and payer-specific reimbursement guidelines. The Major Medical Collector serves as a subject matter expert and collaborates closely with Intake, Authorization Specialists, Pharmacists, Nurses, Billing, Reimbursement, Managed Care, and Finance to reduce accounts receivable aging while improving reimbursement performance.
This position is offered under a hybrid work model.
Essential Duties and ResponsibilitiesAccounts Receivable ManagementManage an assigned portfolio of complex insurance accounts receivable for specialty home infusion pharmacy and home health services.Review daily, weekly, and monthly aging reports to prioritize collection activities.Research and resolve unpaid, underpaid, denied, and suspended claims.Monitor high-dollar infusion claims to ensure timely reimbursement.Identify reimbursement barriers and develop strategies to accelerate payment.Maintain productivity standards for insurance follow-up and collections.Insurance CollectionsConduct comprehensive insurance follow-up with:MedicareMedicare AdvantageMedi-CalManaged Medi-CalCommercial PPO and HMO plansIPA Medical GroupsWorkers' Compensation carriersThird-party administratorsCommunicate directly with insurance representatives regarding outstanding claims, payment status, appeals, authorizations, and reimbursement issues.Resolve coordination of benefits (COB), eligibility issues, medical necessity denials, authorization discrepancies, and contractual payment variances.Escalate unresolved payer issues appropriately while maintaining professional payer relationships.Denials & AppealsInvestigate claim denials to determine root causes.Prepare first-level, second-level, and external appeals with supporting clinical and billing documentation.Coordinate with physicians, pharmacists, nurses, authorization specialists, and intake staff to obtain documentation supporting medical necessity.Monitor appeal deadlines and payer response timelines.Track appeal outcomes and identify trends impacting reimbursement.Recommend operational improvements to reduce future denials.Specialty Home Infusion ReimbursementUtilize advanced knowledge of specialty infusion billing requirements for therapies including, but not limited to:IV AntibioticsIV Immunoglobulin (IVIG)Subcutaneous Immunoglobulin (SCIG)Total Parenteral Nutrition (TPN)Hydration TherapyBiologic MedicationsMonoclonal AntibodiesAnti-infective TherapiesSpecialty Injectable MedicationsUnderstand reimbursement methodologies for medications, nursing services, infusion pumps, supplies, and pharmacy dispensing fees.Review payer policies related to infusion therapy coverage and reimbursement.Revenue Cycle CollaborationCollaborate closely with:
Intake CoordinatorsAuthorization SpecialistsBenefits Verification SpecialistsClinical PharmacistsPharmacy TechniciansHome Infusion NursesAmbulatory Infusion Center (AIC)Billing DepartmentManaged CareFinance Departmentto resolve reimbursement issues before and after claim submission.
Provide recommendations that improve clean claim rates, reduce denials, and strengthen overall revenue cycle performance.
Financial AnalysisReview Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).Identify payment variances, underpayments, duplicate payments, and contractual discrepancies.Verify reimbursement against payer contracts and fee schedules.Assist leadership in identifying payer trends affecting revenue.Prepare documentation supporting recovery of underpaid claims.DocumentationMaintain complete documentation of all collection activities within the billing system.Document payer communications, appeals, claim corrections, payment status, contractual adjustments, and follow-up efforts.Ensure account notes support audit readiness and continuity of follow-up.Quality ImprovementParticipate in departmental productivity meetings and revenue cycle review sessions.Identify trends contributing to reimbursement delays.Recommend workflow improvements that increase reimbursement and reduce accounts receivable aging.Assist with internal audits, payer audits, and accreditation activities.Regulatory ComplianceMaintain compliance with:
Medicare Parts B & D billing regulationsMedi-Cal regulationsCommercial payer reimbursement guidelinesCMS regulationsHIPAA Privacy and Security RulesACHC Accreditation StandardsCalifornia Board of Pharmacy regulationsCompany policies and proceduresMaintain strict confidentiality of all protected health information.
Minimum QualificationsHigh School Diploma or equivalent required.Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Medical Billing, or related field preferred.Minimum 5 years of medical collections experience with a strong emphasis on specialty home infusion pharmacy required.Experience with home health reimbursement strongly preferred.Experience managing high-dollar infusion claims and specialty medication reimbursement.Experience with CPR+ (Mediware), CareTend, Brightree, EnterpriseRx, or similar billing platforms preferred.Knowledge, Skills & AbilitiesRequired KnowledgeAdvanced knowledge of specialty home infusion reimbursement.Home infusion pharmacy billing methodologies.Medicare Parts B & D.Medi-Cal and Managed Medi-Cal reimbursement.Commercial PPO and HMO reimbursement.Pharmacy and nursing billing requirements.HCPCS, CPT, ICD-10-CM, modifiers, revenue codes, and NDC billing.Medical necessity guidelines.Prior authorization requirements.Explanation of Benefits (EOBs).Electronic Remittance Advice (ERA).Coordination of Benefits (COB).Appeals and payer dispute resolution.Required SkillsStrong analytical and critical thinking skills.Excellent organizational and time management abilities.Advanced problem-solving skills.Strong negotiation skills when working with insurance carriers.Excellent written and verbal communication.Intermediate to advanced Microsoft Excel skills.Ability to manage large volumes of complex accounts while meeting productivity standards.Core CompetenciesSpecialty Home Infusion ExpertiseRevenue Cycle ManagementInsurance CollectionsAccounts Receivable ManagementAppeals & Denial ResolutionFinancial AnalysisRegulatory ComplianceAttention to DetailCritical ThinkingCustomer ServiceAccountabilityTeam CollaborationProblem SolvingContinuous ImprovementPerformance ExpectationsThe Major Medical Collector is expected to:
Meet or exceed departmental collection and productivity goals.Reduce insurance accounts receivable aging.Maximize reimbursement for specialty infusion pharmacy and home health services.Maintain high-quality documentation of all collection activities.Resolve denials and appeals within established turnaround times.Maintain compliance with all payer, regulatory, accreditation, and company requirements.Identify reimbursement trends and contribute to process improvement initiatives.Support Oso Home Care's commitment to financial stewardship while ensuring patients continue to receive medically necessary infusion therapies.Why Join Oso Home Care?Founded in 1984, Oso Home Care is a privately owned leader in specialty home infusion pharmacy, ambulatory infusion center services, and home health care. We are dedicated to delivering exceptional patient care through clinical excellence, innovation, and compassionate service.
At Oso Home Care, our Billing & Reimbursement team plays a vital role in supporting patient access to life-sustaining infusion therapies. We offer a collaborative, family-oriented work environment, opportunities for professional growth, and the chance to make a meaningful impact on both our patients and our organization.
Oso Home Care is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by federal, state, or local law.
Read LessOso Home Care is hiring a full-time Pharmacy Technician. Must have sterile compounding experience. We are seeking an energetic, customer-focused, team player for fast-paced home infusion pharmacy. We are located in Burbank, CA,
Hours: Monday to Friday with rotating weekends.
Job Duties:
Sterile compounding.Communicating with various healthcare professionals, to include authorizations and benefit teams.Providing outstanding customer service.Job Requirements:
High school diploma.Active Pharmacy Technician license.Excellent customer service skills.Proficient in basic mathematics.Family owned, room for growth, rewarding, fun and supportive atmosphere.
We are a privately owned corporation founded in 1984. http://osohomecare.com
Oso Home Care is an equal opportunity employer. Oso Home Care does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status, or any other characteristic protected by law.
Applicant and employee privacy policy can be found at https://osohomecare.com
Read LessOso Home Care is seeking an experienced Home Infusion Biller to join our Billing & Reimbursement Department. Since 1984, Oso Home Care has been a leader in specialty home infusion pharmacy, ambulatory infusion center (AIC) services, and home health throughout Southern California.
The Home Infusion Biller is responsible for the accurate and timely billing of specialty infusion pharmacy medications, supplies, nursing services, and ambulatory infusion center (AIC) services. This position manages the billing process from claim creation through reimbursement by ensuring claims are submitted accurately, claim edits are resolved, denials are appealed, and insurance follow-up is completed in accordance with payer requirements.
The Home Infusion Biller works closely with Intake, Authorization Specialists, Benefits Verification, Pharmacy, Nursing, Reimbursement, and Revenue Cycle teams to ensure complete documentation, accurate billing, and timely reimbursement while maintaining compliance with Medicare, Medi-Cal, commercial insurance, and accreditation standards.
Essential Duties and ResponsibilitiesMedical BillingPrepare, review, and submit accurate electronic and paper claims for home infusion pharmacy services, infusion nursing visits, ambulatory infusion center (AIC) treatments, specialty medications, and related services.Ensure all billing is supported by physician orders, nursing documentation, delivery records, medication administration records, and required clinical documentation.Submit claims utilizing appropriate HCPCS, CPT, ICD-10-CM, NDC, modifiers, and payer-specific billing requirements.Review claims for completeness and accuracy prior to submission.Ensure claims are billed within established departmental turnaround standards.Claim ProcessingReview electronic claim edits and clearinghouse reports.Correct billing errors and resubmit rejected claims.Resolve claim edits related to coding, documentation, eligibility, authorization, or payer requirements.Monitor claim acceptance and payment status through payer portals and electronic remittance systems.Denial ResolutionResearch denied and partially paid claims.Determine the cause of denials and implement corrective actions.Prepare corrected claims and supporting documentation for resubmission.Submit appeals when appropriate and monitor payer response timelines.Collaborate with Intake, Authorization Specialists, Pharmacy, Nursing, and physician offices to obtain additional documentation needed for reimbursement.Insurance Follow-UpFollow up on outstanding claims with Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, and commercial insurance carriers.Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) for payment accuracy.Resolve claim payment discrepancies, coordination of benefits (COB), underpayments, and contractual adjustments.Maintain detailed documentation of all payer communications and account activity.Revenue Cycle CollaborationWork collaboratively with Intake, Authorization, Benefits Verification, Pharmacy, Nursing, and Reimbursement teams to resolve billing issues that impact reimbursement.Identify trends that contribute to billing delays or denials and communicate recommendations for process improvement.Assist with payer audits, documentation requests, and reimbursement reviews.ComplianceMaintain compliance with:Medicare and Medi-Cal billing regulationsCommercial payer billing requirementsCMS reimbursement guidelinesHIPAA Privacy and Security RulesACHC accreditation standardsCalifornia Board of Pharmacy regulationsCompany policies and proceduresMaintain confidentiality of patient health information in accordance with HIPAA.Minimum QualificationsHigh School Diploma or equivalent required.Associate degree in Medical Billing, Healthcare Administration, or related field preferred.Minimum of 2 years of medical billing or collections experience in Home Infusion, Specialty Pharmacy, Home Health, or Infusion Services.Experience with CPR+ (Mediware), CareTend, or similar healthcare billing software preferred.Experience billing Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, and commercial insurance plans.Knowledge, Skills & AbilitiesThorough knowledge of medical billing procedures and revenue cycle processes.Working knowledge of Medicare, Medi-Cal, and commercial payer billing requirements.Knowledge of CMS reimbursement guidelines.Familiarity with HCPCS, CPT, ICD-10-CM, and NDC coding.Understanding of insurance eligibility, benefits verification, coordination of benefits, and prior authorization requirements.Knowledge of medical terminology and infusion pharmacy services.Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and electronic medical record (EMR) systems.Strong analytical, organizational, and time management skills.Excellent written and verbal communication skills.Ability to prioritize multiple tasks while meeting productivity and billing deadlines.Strong mathematical skills with the ability to calculate payments, contractual adjustments, percentages, and reimbursement variances.Core CompetenciesMedical BillingRevenue Cycle KnowledgeAttention to DetailCritical ThinkingProblem SolvingTime ManagementCustomer ServiceCommunicationTeamworkAccountabilityRegulatory ComplianceOrganizational SkillsPerformance ExpectationsThe Home Infusion Biller is expected to:
Submit accurate and timely claims with a high clean claim rate.Maintain productivity standards for billing and insurance follow-up.Resolve claim denials within established turnaround times.Maintain accurate documentation of all billing activity.Support departmental goals related to reimbursement, accounts receivable, and cash flow.Maintain compliance with all payer, regulatory, accreditation, and company requirements.Collection-based incentive opportunities may be available based on departmental performance and company policy.
About Oso Home CareFounded in 1984, Oso Home Care is a privately owned specialty home infusion pharmacy providing infusion therapy, ambulatory infusion services, and home health care throughout Southern California. We are committed to delivering exceptional patient care through clinical excellence, innovation, compassion, and teamwork.
Oso Home Care is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other status protected by applicable federal, state, or local law.
Read LessLVN Case Manager
Job Description
Oso Home Care Inc. is looking to hire a full-time LVN case manager. Our main office is located in Irvine, CA where the 405 and 55 freeways meet. Candidate must be IV certified. This is an in office/in clinic LVN role supporting our home and clinic infusion patients and nurses. Training to take place in our Irvine location and then transfer to our Long Beach, CA ambulatory infusion center.
Hours:
Monday through Friday, 8:00 am – 7:00 pm (8 hours shifts: varying starting/closing shifts to support business needs)
Responsibilities:
Organize patient's plan of care from the moment the patient starts on service to the moment they discharge from the agency.Communicate with providers, insurance companies, nurses, pharmacy staff, and patients/families.Assist AIC nurses in obtaining provider orders, starting IV’s & case managing all aspects of patient care needs.Willingness to learn all aspects of infusion therapy within the scope of an LVN.Requirements:
Current unrestricted CA LVN license.IV certification.Strong communication, organizational, and documentation skills are a must.Ability to work independently and as part of a teamFlexibility to train/interview in our Irvine location with future possibility to transfer to our Long Beach ambulatory infusion center location when training is complete.Preferred:
Experience with PICC lines, implanted ports, and IV therapy within LVN scope of practice.Experience starting IV’s and drawing blood.Spanish speaking is a plus but not required.Prior experience working in a fast-paced clinical support environment.Oso Home Care Inc is an Equal Opportunity Employer and complies with all local, state, and federal laws.
Applicant and employee privacy policy can be found at: https://osohomecare.com
Read Less