Collections Specialist - Evernorth - Remote

Collections Specialist- Enrollment/Billing Representative

Join a team where your work truly matters. As a Collections Specialist, you will play a key role in supporting financial health for our patients and organization. You will be responsible for managing third-party billing and collections, ensuring timely and accurate payment of claims, and processing payer appeals. This role involves investigating denials, processing rejections, and identifying root causes of payment issues, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, pharmacy claims, medical billing practices, and payer reimbursement guidelines, as well as effective communication and critical thinking skills. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.

Hours: Monday-Friday, 8am-4:30pm ET

Responsibilities

• Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials.

• Identify trends or payment challenges and take action to support resolution and prevent future issues.

• Process all Payer appeal requests within the time limit required by the Payer.

• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer.

• Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid, and whether additional approval is required.

• Identify errors, correct claims, and reprocess for reimbursement.

• Review claim processing to determine proper payment has been issued.

• Accurately identify adjustments needed and take proper action to prevent further adjustments.

• Submission of claims investigations and reviewing payer contracts for reimbursement.

• Communication with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.

• Review and analyze reports to track account activity and highlight opportunities for improvement.

• Ensure all work meets quality assurance and benchmark standards set by the management team.

• Work independently and as part of a team.

• Documents all collections activity in patient collections notes and AR Reports.

Qualifications

Required:

• High school diploma or equivalent.

• 1+ year of experience in home infusion medical and/or pharmacy billing practices

• Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams, and Excel.

• Excellent interpersonal, organizational, communication and effective critical thinking skills.

• Experience with ICD-10, CPT-4, HCPCS, and medical terminology.

• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due.

• Maintain confidentiality and practice discretion and caution when handling sensitive information.

• Ability to read and interpret an EOB for accurate understanding of claim processing.

Preferred:

• HCN360 and CPR+ knowledge.

• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due.

About Evernorth and CarepathRx

As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our teams are ambitious, compassionate experts who partner with hospitals and health systems to advance specialty pharmacy and infusion services. Everything we do is centered on improving patient outcomes-together.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here ( .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email View email address on jobs.institutedata.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.