[Remote] Enrollment/Billing Representative

Note: The job is a remote job and is open to candidates in USA. The Cigna Group is dedicated to improving the health and vitality of those they serve. They are seeking a Medical Collections Specialist for their Revenue Cycle Team, responsible for the collections of insurance claims and ensuring compliance with billing guidelines.

Responsibilities

• Understand Third Party Billing and Collection Guidelines
• Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials
• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management
• Contacts payer, or patient as appropriate
• Documents all collections activity in patient collections notes
• Documents work performed/action taken on AR Aging Report and/or Over/Under Report
• Process all Payer appeal requests within the time frame required by the Payer
• Processes all approved adjustments
• 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
• Able to identify errors, correct claims and reprocess for reimbursement
• Able to read and interpret an EOB for accurate understanding of denial
• Knows how to investigate claims, contracts for reimbursement
• Performs other duties as assigned

Skills

• High school graduate or equivalent
• Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary
• 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
• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence
• Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner
• Helpful, knowledgeable, and polite while maintaining a positive attitude
• Interpret a variety of instructions in a variety of communication mediums
• 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
• Employment is contingent on background investigation (company-wide)
• Employment is contingent on drug screen (when applicable for the position)
• Valid driver's license in state of residence with a clean driving record (when applicable for the position)
• Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology
• Knowledge of Home Infusion
• Knowledge of insurance policies and requirements
• Knowledge of medical billing practices and of billing reimbursement
• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due
• Medicare knowledge of billing requirements specific to DMEMAC
• HCN360 and CPR+ knowledge

Benefits

• 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.

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