Enrollment/Billing Representative

Cigna Healthcare•Oakdale, PA

2d•Remote

About The Position

The Billing Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate billing of claims. This role involves billing medical and NCPDP claims, identifying and resolving root cause of rejections, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.

Requirements

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.
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.

Nice To Haves

Knowledge of Home Infusion.
Knowledge of insurance policies and requirements.
Knowledge of medical billing practices and of billing reimbursement.
Collections or medical billing experience with basic understanding of ICD910, CPT4, HCPCS, and medical terminology is preferred.
Basic knowledge of Microsoft Office.
Knowledge of HCN 360 and/or CPR+ preferable.
Medicare knowledge of billing requirements specific to DMEMAC.

Responsibilities

Understand Third Party Billing.
Ensure the timeliness and accuracy of billing.
Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
Identifies patient and insurance changes.
Processes Home Infusion/Nursing claims.
Processes rejections for NCPDP claims to determine if the claim needs to be refiled or submitted for an appeal with the payer.
Able to identify billing trends.
Performs other duties as assigned.