Enrollment/Billing Senior Representative, Home Infusion - Evernorth- Remote

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About the role

Senior Collections Specialist – Enrollment/Billing Senior Representative Job Summary As a Senior Collections Specialist, you play a vital role in strengthening financial performance while improving the patient experience. You bring curiosity, persistence, and compassion to complex payer challenges—ensuring claims are resolved accurately, reimbursement is timely, and patients and partners are supported every step of the way. If you thrive in problem solving and want your work to make a meaningful impact, this role offers the opportunity to grow your expertise while contributing to high‑quality, patient‑centered care. Hours: Monday- Friday, 8:30am-5pm EST Responsibilities Drive timely and accurate reimbursement by actively managing pharmacy claim billing, collections, and follow‑up activities. Resolve denied, rejected, or underpaid claims by identifying root causes and applying corrective strategies that prevent repeat issues. Interpret explanations of benefits (EOBs) to validate reimbursement accuracy and determine next steps. Monitor accounts receivable and take ownership of outstanding balances through persistent payer or patient outreach. Prepare, submit, and track payer appeals within required timeframes, ensuring documentation supports favorable outcomes. Evaluate payer rules and reimbursement guidelines to determine whether claims should be corrected, refiled, or appealed. Ensure claim accuracy by identifying and correcting billing or submission errors that impact reimbursement. Maintain clear, timely documentation of collection activity in patient notes and reporting tools. Partner with teammates and leaders to identify workflow improvements that strengthen efficiency, compliance, and financial performance. Qualifications Required Qualifications High school diploma or GED. Minimum of 2 years of experience in collections, A/R, medical billing, healthcare claims, pharmacy billing, or insurance‑related collections. Working knowledge of payer reimbursement processes including commercial, Medicare, Medicaid, self‑pay, and third‑party plans. Ability to read and interpret explanations of benefits (EOBs) and billing correspondence. Strong communication, organization, and problem‑solving skills with a customer‑focused mindset. Proficiency in Microsoft 365 and electronic health or billing systems. Preferred Qualifications 2 or more years of experience in revenue cycle operations, pharmacy billing, or collections. Experience working with ICD‑10, CPT, HCPCS, and Medicare billing guidelines. Knowledge of pharmacy Part D claims, CE2000, home infusion billing, and third‑party payer rules. Experience using systems such as HCN360, CPR+, or comparable billing platforms. About the Team This role supports CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery organization. Together, we partner with hospitals and health systems to deliver specialty pharmacy and infusion services with precision, compassion, and expertise. 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 20 - 30 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 reim

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