Senior Enrollment/Billing Representative, Home Infusion

This is a fully remote position, open to applicants in Florida, +6 more states.

📋 Description

• Proactively oversee pharmacy claim billing, collections, and follow-up tasks.

• Address denied, rejected, or underpaid claims by pinpointing root causes and implementing corrective measures.

• Analyze explanations of benefits (EOBs) to verify reimbursement accuracy and assess subsequent steps.

• Track accounts receivable and manage outstanding balances through outreach to payers or patients.

• Prepare, submit, and monitor payer appeals within mandated timeframes.

• Assess payer regulations and reimbursement guidelines to determine whether claims require correction, refiling, or appeals.

• Detect and rectify billing or submission mistakes impacting reimbursement.

• Ensure timely documentation of collection efforts in patient notes and reporting tools.

• Collaborate with colleagues and leadership to identify workflow enhancements that boost efficiency, compliance, and financial results.

• Assist CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery organization in providing specialty pharmacy and infusion services.

⛳️ Requirements

• High school diploma or GED is required.

• At least 2 years of experience in collections, accounts receivable, medical billing, healthcare claims, pharmacy billing, or insurance-related collections.

• Familiarity with payer reimbursement processes, including commercial, Medicare, Medicaid, self-pay, and third-party plans.

• Capability to read and interpret explanations of benefits (EOBs) along with billing correspondence.

• Excellent communication, organizational, and problem-solving abilities with a customer-oriented approach.

• Proficient in Microsoft 365 and electronic health or billing systems.

• Experience in revenue cycle operations, pharmacy billing, or collections is preferred.

• Background in working with ICD-10, CPT, HCPCS, and Medicare billing guidelines is preferred.

• Knowledge of pharmacy Part D claims, CE2000, home infusion billing, and third-party payer regulations is preferred.

• Experience utilizing HCN360, CPR+, or similar billing platforms is preferred.

• For remote work, cable broadband or fiber optic internet service with a minimum of 10Mbps download/5Mbps upload is required.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits beginning on day one.

• Access to well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence available.

• Remote work arrangement offered.

• Requirement for cable broadband or fiber optic internet for home working.