Enrollment/Billing Representative

The Cigna Group

1d•$18 - $26•Hybrid

About The Position

We are seeking a dedicated Medical Collections Specialist for our Revenue Cycle Team. In this position you will be responsible for the collections of insurance claims.

Requirements

High school graduate or equivalent.
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
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
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
Background investigation (company-wide)
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)
Must be eligible to work in this country.

Nice To Haves

Knowledge of Home Infusion
Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
Medicare knowledge of billing requirements specific to DMEMAC
HCN360 and CPR+ knowledge preferred.

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