The Cigna Group logo
The Cigna Group

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Medical Billing Specialist

Medical Billing and CodingMedical Billing and CodingOtherRemoteMid LevelTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

2 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Medical Billing Specialist

The Cigna Group

Role Description The Medical Billing Specialist is responsible for managing third-party billing and collections activities to ensure the timely and accurate submission, processing, and resolution of medical and pharmacy claims. The ideal candidate has experience with home infusion billing, payer reimbursement guidelines, and medical billing practices, along with strong analytical, communication, and problem-solving skills. - Manage third-party billing and collections activities. - Ensure the timely and accurate submission of claims. - Meet quality assurance standards, productivity goals, and performance benchmarks. - Identify and update patient and insurance information changes. - Process home infusion and nursing claims. - Review and resolve NCPDP claim rejections, including resubmissions and appeals as appropriate. - Analyze billing trends and identify opportunities for process improvement. - Maintain accurate documentation and records. - Perform other duties as assigned. Qualifications - Strong verbal and written communication skills with patients, payers, external agencies, and internal stakeholders. - Professional, courteous, and customer-focused approach. - Ability to interpret and apply instructions received through various communication methods. - Knowledge of home infusion services and related billing practices. - Understanding of insurance policies, payer requirements, and reimbursement processes. - Knowledge of medical billing methodologies and reimbursement regulations. - Ability to maintain confidentiality and handle sensitive information with discretion. - Strong organizational skills with excellent attention to detail. - Ability to manage multiple priorities in a fast-paced environment. - Basic mathematical proficiency, including addition, subtraction, multiplication, and division. - Strong problem-solving, time management, and critical-thinking skills. - Ability to work independently and collaboratively within a team environment. - Knowledge of ICD-10, CPT, HCPCS codes, and medical terminology preferred. - Proficiency with Microsoft 365 applications. - Experience with HCN 360 and/or CPR+ preferred. - Working knowledge of Medicare billing requirements, including DME MAC guidelines preferred. Requirements - High school diploma or GED required. - One to three years of related billing, collections, or healthcare revenue cycle experience. - Experience in a medical, healthcare, or home infusion environment preferred. - Experience with medical billing and administrative record management. - Strong customer service and interpersonal skills. - Excellent organizational, communication, and problem-solving abilities. Preferred Qualifications - Home infusion billing or collections experience. - Experience billing both medical and pharmacy claims. - Familiarity with Medicare, commercial payers, and reimbursement regulations. - Experience working with claim denials, appeals, and reimbursement resolution. Benefits - 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.

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