Collections Specialist

The Cigna Group•Oakdale, PA

3d•Hybrid

About The Position

Join a team where your work truly matters. As a Collections Specialist, you will play a key role in supporting financial health for our patients and organization. You will be responsible for managing Self-Pay Collections, ensuring timely and accurate payment of claims, handling in-bound patient calls, and reviewing co-pay assistance claims. The ideal candidate will have strong customer service skills, communication and critical thinking skills and experience working in a fast-paced environment. This role involves investigating accuracy and account review with the goal of resolving discrepancies and maximizing reimbursement. Prior knowledge of home infusion, medical billing practices, and payer reimbursement guidelines is preferred. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and medical terminology is preferred.

Requirements

High school diploma or equivalent.
Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams, and Excel.
Minimum of 1–2 years of experience in billing, collections, or related field.
Excellent interpersonal, organizational, communication and effective critical thinking skills.
Strong customer service.
Maintain confidentiality and practice discretion and caution when handling sensitive information.
Ability to read and interpret an EOB for accurate understanding of claim processing.

Nice To Haves

HCN360 and CPR+ knowledge.
Experience with ICD-10, CPT-4, HCPCS, and medical terminology.
Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due.
Prior knowledge of home infusion.

Responsibilities

Support accurate and timely billing and collections to reduce outstanding balances
Manage assigned book of business: Transfer of balance due, charging of patient ACH and Credit Card and one-time credit cards for copay assistance payments, and contractual adjustments requests of accounts.
Contacting patients or payers as appropriate.
Review accounts with patients and resolve questions or transfer to appropriate staff member. Inbound and outbound call volumes may vary throughout the month.
Partner with copay assistance programs and internal teams to resolve payment and billing issues.
Review claim processing to determine proper payment has been issued.
Accurately identify adjustments needed and take proper action to prevent further adjustments.
Identify trends or payment challenges and take action to support resolution and prevent future issues.
Review and analyze reports to track account activity and highlight opportunities for improvement.
Ensure all work meets quality assurance and benchmark standards set by the management team.
Work independently and as part of a team.
Documents all collections activity in patient collections notes and AR Reports.
Review patient unapplied account and verify accuracy of payment prior to posting to the correct open account receivable.