Collections Specialist II, Home Infusion - Evernorth - Remote
About this role
Job Summary
The Collections Specialist II is responsible for managing insurance collections, resolving claim denials, processing appeals, and ensuring accurate and timely reimbursement. This role requires experience in medical billing, payer guidelines, and accounts receivable management, with a focus on identifying and resolving payment issues. Knowledge of home infusion and healthcare reimbursement processes is preferred.
Key Responsibilities
- Manage third-party billing and collections activities.
- Investigate and resolve claim denials, rejections, and underpayments.
- Submit payer appeals and monitor timely follow-up.
- Review claims, EOBs, and patient accounts to determine appropriate next steps.
- Correct and reprocess claims for reimbursement when necessary.
- Document collection efforts and actions taken on accounts.
- Communicate with payers, patients, and internal teams to resolve outstanding balances.
- Maintain quality, productivity, and compliance standards.
- Perform other duties as assigned.
Qualifications
- High school diploma or equivalent.
- 3+ years of medical collections, billing, or healthcare revenue cycle experience.
- Knowledge of insurance reimbursement, claim processing, and payer guidelines.
- Understanding of ICD-10, CPT, HCPCS, and medical terminology preferred.
- Home infusion, Medicare, or DME billing experience preferred.
- Strong problem-solving, organizational, and communication skills.
- Ability to work independently, manage multiple priorities, and maintain attention to detail.
- Proficiency with Microsoft 365 (Outlook, Teams, Excel).
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 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 reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. 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 seeyourself@thecignagroup.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.
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