Experienced Oncology Medical Biller

POSITION DESCRIPTION Oncology Revenue Cycle Specialist CAR-T Cell Therapy and Advanced Immunotherapy Billing Department: Revenue Cycle Management Employment Type: Full-Time | Remote Eligible Compensation: Commensurate with experience POSITION OVERVIEW We are seeking an experienced Oncology Revenue Cycle Specialist with demonstrated expertise in CAR-T cell therapy billing and advanced immunotherapy reimbursement. This is a highly specialized role requiring clinical fluency, deep knowledge of REMS compliance frameworks, and proficiency in the end-to-end billing lifecycle for high-dollar, low-volume oncology procedures. The ideal candidate understands that a single CAR-T claim can represent $350,000 to $500,000 in reimbursement and approaches every coding decision, prior authorization, and appeal with the precision and urgency that level of financial responsibility demands. This is not a generalist billing role. It requires a specialist who is equally comfortable building processes from scratch, operating in a startup environment, and functioning as an embedded partner within a clinical organization. We do not operate as an outside billing resource. For clients who want it, we work as an embedded partner inside their operations. This biller will be expected to do the same -- proactively sharing intelligence, identifying workflow gaps, and contributing to the ongoing optimization of billing processes alongside clinical and administrative teams. KEY RESPONSIBILITIES CAR-T Episode Billing Code the complete five-phase CAR-T treatment episode including Phase 1 apheresis and cell collection; Phase 2 lymphodepleting chemotherapy; Phase 4 post-infusion monitoring through Day plus 14 (daily E&M, labs, CRS/ICANS management including J3262 tocilizumab, G0378 observation, hydration, therapeutic infusions); and Phase 5 extended monitoring through Day plus 30 where the center remains the treating facility for late-occurring toxicities. Apply correct modifiers including JW for drug amount wasted, JZ for no drug wasted, modifier 59, and place-of-service codes for outpatient facility settings. Capture and attach REMS authorization numbers, drug lot numbers, units administered, patient enrollment identifiers, and chain-of-identity and chain-of-custody documentation on all applicable claims. Sequence multi-phase CAR-T episodes accurately to ensure correct claim order and avoid triggering bundling edits. Understand that Phase 5 billing does not follow a clean handoff. The treating center may remain responsible for supportive care through Day plus 30 if late toxicities occur, and billing must reflect that accurately. Code all E&M services across the full episode. E&M coding is within scope for this role and is not treated as a separate billing function. Workflow Development and Optimization Design charge capture workflows for CAR-T treatment episodes from the ground up. This is not a role where established systems are handed to you. The right candidate can map every billable touchpoint across a five-phase episode, identify documentation gaps that cause claim failures, and build processes that maximize capture of all legitimate reimbursement. Continuously evaluate and adjust billing workflows as payer policies, coding guidelines, and REMS program requirements evolve. Revenue optimization is an ongoing process, not a one-time setup. Contribute actively to operational discussions about how documentation, clinical workflows, and billing workflows intersect. Bring billing intelligence into those conversations proactively. Prior Authorization Management Initiate, track, and escalate prior authorization requests for CAR-T drugs and procedures across Medicare, Medicare Advantage, and commercial payers. Prepare complete prior authorization submission packets including cover pages, clinical eligibility checklists, letters of medical necessity, and required attachments. For commercial payers with CAR-T-specific policies, this includes documentation of relapsed/refractory disease with prior lines of therapy, ECOG performance status, organ function labs, FACT-aligned facility capability statements, and chain-of-identity and chain-of-custody documentation. Coordinate peer-to-peer review requests between treating physicians and payer medical directors. Maintain real-time prior authorization status and communicate proactively with clinical staff on approvals, denials, and expirations. Denial Management and Appeals Work all CAR-T and E&M claim denials with urgency given the high per-claim dollar value. Draft detailed clinical and coding appeal letters with supporting documentation including ASTCT CRS grading documentation for tocilizumab claims, clinical justification for observation claims including fever threshold, hemodynamic status, and neurological changes, and chain-of-custody verification for infusion day claims. Identify denial patterns by payer and code type and escalate systemic issues with corrective action recommendations. Understand payer-specific adjudication rules: 0540T must be paired with the applicable drug HCPCS code or the claim will be denied; observation is frequently downcoded unless documentation explicitly states clinical indicators; tocilizumab requires ASTCT grading in the clinical notes. REMS Compliance Documentation Maintain current and complete REMS compliance files for each CAR-T product administered including facility certification status, provider certifications, and patient enrollment records. Verify REMS certification is active and current before submitting any CAR-T drug claim. Coordinate with clinical staff to ensure REMS documentation is captured at the point of care. Monitor FDA REMS program updates for all administered CAR-T products and communicate changes to the team. Single Case Agreements and Contract Support Understand what a single case agreement is, when one is appropriate for a CAR-T case, and how to support the process including gathering clinical and operational documentation, understanding payer adjudication logic, and communicating with payer representatives. Support payer contract analysis including rate review, coverage policy assessment, and identification of negotiation opportunities. This is not a primary contract negotiation role, but the right candidate understands the landscape and can contribute meaningfully to the process. Payer and Reimbursement Management Reconcile CAR-T drug reimbursements against acquisition cost on all buy-and-bill claims. Flag and pursue underpayments. Monitor payer downcoding of observation and other services and dispute where documentation supports the original code. Maintain current knowledge of Medicare LCD/NCD policies for CAR-T and commercial payer coverage guidelines. Support clinical trial billing compliance including coverage analysis and routine versus research cost separation per Medicare NCD 310.1 where applicable. Credentialing Support Assist with provider and facility enrollment applications for Medicare and commercial payers. Maintain credentialing files and track re-credentialing deadlines for all rendering providers. Coordinate with payers on enrollment status inquiries and resolve credentialing-related claim holds. Reporting and Intelligence Sharing Produce accurate monthly AR aging reports, denial summaries, and collection analyses. Proactively share payer policy updates, REMS program changes, and coding guideline revisions with the team without waiting to be asked. Document all billing activity, follow-up actions, and resolution notes in the practice management system. REQUIRED QUALIFICATIONS Education and Certification High school diploma or equivalent required. Associate's or Bachelor's degree in Health Information Management, Business, or related field preferred. Certified Professional Coder (CPC) through AAPC required. Certified Oncology Coder (COC) or Oncology Certified Coder (OCC) strongly preferred. REMS program training or certification for any CAR-T product a significant advantage. Experience Minimum 3 to 5 years of medical billing experience with at least 2 years specifically in oncology or hematology billing. Direct experience billing CAR-T cell therapy claims (Yescarta, Kymriah, Breyanzi, Carvykti) highly preferred. Demonstrated experience with buy-and-bill drug reimbursement, J-code billing, and drug waste modifier application. Prior authorization experience with high-cost oncology drugs required. Experience working with Medicare Part B, Medicare Advantage, and commercial payer oncology policies. Experience in a startup, early-stage, or build-from-scratch environment strongly preferred. Candidates who have only worked in large, fully-resourced billing departments where processes were already established may not be the right fit for this role. Technical Knowledge Proficiency with CPT Category III codes (0540T) and HCPCS Level II drug codes for CAR-T products (Q2041 through Q2057). Working knowledge of REMS compliance requirements for FDA-approved CAR-T therapies. Understanding of payer-specific CAR-T adjudication rules including prior authorization requirements, chain-of-custody documentation standards, ASTCT CRS grading requirements for tocilizumab claims, and observation downcoding risk. Familiarity with oncology EMR and practice management systems. Experience with platforms designed for oncology-specific workflows a plus. Proficiency with clearinghouse platforms and electronic remittance advice processing. Understanding of outpatient facility billing versus professional billing and applicable place-of-service coding. PREFERRED QUALIFICATIONS Experience designing or building charge capture workflows for complex multi-phase treatment episodes. Experience with single case agreements and payer contract support. Knowledge of CAR-T REMS programs: YESCARTA/TECARTUS REMS, KYMRIAH REMS, BREYANZI REMS, CARVYKTI REMS. Experience billing clinical trial claims and performing coverage analysis under Medicare NCD 310.1. Experience with split-billing models where facility and professional fees are billed by separate entities. Background in infusion center or outpatient oncology center billing (not hospital-based). Experience with payer contract analysis and underpayment identification. Bilingual English/Spanish a plus. CORE COMPETENCIES Clinical Fluency: Understands what CAR-T therapy is, how it works, why each phase of the episode exists, and what the clinical documentation requirements are at each step. Not just the codes. Workflow Builder: Can design a charge capture process from scratch, identify gaps, and improve it continuously. Does not wait for someone else to hand them a finished system. REMS Discipline: Treats REMS documentation as non-negotiable. Never submits a CAR-T drug claim without verifying compliance. Payer Intelligence: Knows how Medicare, Medicare Advantage, and major commercial payers approach CAR-T coverage differently. Understands payer-specific adjudication rules and documentation thresholds. Startup Mindset: Comfortable operating in an environment where not everything is built yet. Resourceful, self-directed, and able to create structure where it does not exist. Embedded Partner Behavior: Shares information proactively. Brings payer policy changes, REMS updates, and coding guideline revisions to the team without waiting to be asked. Participates in operational conversations, not just billing transactions. Proactive Communication: Flags issues before they become denials. Keeps clinical and administrative staff informed on authorization status and billing risks. Accuracy Under Pressure: Consistently correct on high-dollar claims where errors carry significant financial and compliance consequences. Resilient Appeals: Fights denials with well-documented clinical and coding arguments. Does not accept underpayments. Adaptability: Thrives in a fast-evolving field where CAR-T billing rules, payer policies, and REMS requirements change frequently. WORK ENVIRONMENT AND EXPECTATIONS Remote-Eligible: This position may be performed remotely. Candidates must have a secure, HIPAA-compliant home office environment with reliable high-speed internet. Turnaround Standards: CAR-T claims must be submitted within 3 business days of complete documentation receipt. Prior authorization follow-up required within 24 hours of status change. Denial responses filed within 5 business days. Confidentiality: This role involves access to highly sensitive patient health information and high-value financial data. Strict adherence to HIPAA and all applicable confidentiality policies is mandatory. Continuing Education: We support and expect ongoing education in oncology coding, REMS program updates, and payer policy changes. CPC or COC credential maintenance required. HOW TO APPLY Please submit your resume along with a brief description of your direct experience with CAR-T billing, including which products you have billed for, which payers you have worked with, and whether you have experience building billing workflows in a startup or early-stage environment. Applications without oncology billing experience will not be considered.