Collections Specialist II, Home Infusion
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Job Description
Collections Specialist managing insurance claims, denials, appeals, and reimbursement for Evernorth’s home infusion services. Supporting CarepathRx’s specialty pharmacy and infusion operations.
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
- Support CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery organization
Requirements:
- 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)
- For home working, internet connection through a cable broadband or fiber optic internet service provider with at least 10Mbps download/5Mbps upload
Benefits:
- Annual bonus plan eligibility
- Medical insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home working
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