Senior Enrollment/Billing Representative, Home Infusion

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Ensure timely and accurate reimbursement by overseeing pharmacy claim billing, collections, and follow-up actions.

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

• Analyze explanations of benefits (EOBs) to confirm reimbursement accuracy and outline subsequent steps.

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

• Prepare, submit, and monitor payer appeals within specified deadlines.

• Assess payer regulations and reimbursement guidelines to decide if claims should be corrected, refiled, or appealed.

• Identify and rectify billing or submission errors that affect reimbursement.

• Keep a record of collection activities in patient notes and reporting tools.

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

• Provide support to CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery division.

⛳️ 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) and billing communications.

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

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

• Preferred: 2 or more years of experience in revenue cycle operations, pharmacy billing, or collections.

• Preferred: Experience with ICD-10, CPT, HCPCS, and Medicare billing guidelines.

• Preferred: Understanding of pharmacy Part D claims, CE2000, home infusion billing, and third-party payer regulations.

• Preferred: Experience using systems such as HCN360, CPR+, or similar billing platforms.

🏝️ Benefits

• Eligibility for an annual bonus plan.

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

• Programs for well-being and behavioral health.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement available.

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

• Paid holidays.

• Options for leaves of absence.

• Tobacco-free workplace policy.

• Support for home internet requirements for occasional or permanent remote work.