Enrollment/Billing Representative

Location: Remote

Summary

• The Billing Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate billing of claims. This role involves billing medical and NCPDP claims, identifying and resolving root cause of rejections, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving 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.

Essential Duties & Responsibilities

• Understand Third Party Billing.
• Ensure the timeliness and accuracy of billing.
• Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
• Identifies patient and insurance changes.
• Processes Home Infusion/Nursing claims.
• Processes rejections for NCPDP claims to determine if the claim needs to be refiled or submitted for an appeal with the payer.
• Able to identify billing trends.
• Performs other duties as assigned.

Knowledge, Skills & Abilities

• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
• Helpful, knowledgeable, and polite while maintaining a positive attitude.
• Interpret a variety of instructions in a variety of communication mediums.
• Knowledge of Home Infusion.
• Knowledge of insurance policies and requirements.
• Knowledge of medical billing practices and of billing reimbursement.
• Maintain confidentiality and practice discretion and caution when handling sensitive information.
• Multi-task along with attention to detail.
• Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division.
• Self-motivation, organized, time-management and deductive problem-solving skills.
• Work independently and as part of a team.
• Collections or medical billing experience with basic understanding of ICD910, CPT4, HCPCS, and medical terminology is preferred.
• Basic knowledge of Microsoft Office.
• Knowledge of HCN 360 and/or CPR+ preferable.
• Medicare knowledge of billing requirements specific to DMEMAC.

Requirements

• Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
• High school diploma or GED equivalent.
• One to three years of related prior work experience in a team-oriented environment.
• Experience in medical field and administrative record management.
• Strong customer service background.

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.

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 [email protected] 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.