Collections Specialist, Specialty- Evernorth in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Collections Specialist, Specialty – Evernorth based in the United States.

The Collections Specialist will play an essential role in supporting patient billing and reimbursement operations within the home infusion and specialty pharmacy sectors. In this position, you will help optimize reimbursement outcomes by managing collections, resolving billing discrepancies, and ensuring timely and accurate claim processing. You will investigate claim denials, identify underlying issues, and coordinate appeals to improve payment recovery. Working closely with patients, insurance payers, and internal teams, you will contribute to stronger account management and a smoother reimbursement experience. This role offers the opportunity to make a meaningful difference in healthcare delivery while supporting financial accuracy and patient access to essential services. You will join a collaborative, performance-driven environment that values problem-solving, customer service, and continuous improvement.

• Manage billing and collections activities to support timely and accurate reimbursement.
• Investigate claim denials, identify root causes, and implement appropriate solutions to prevent recurring issues.
• Prepare and submit payer appeals within established deadlines, working to improve approval and reimbursement rates.
• Monitor and analyze accounts receivable to identify outstanding balances, resolve discrepancies, and reduce payment delays.
• Collaborate with insurance payers, patients, and internal departments to resolve billing questions and outstanding account balances.
• Maintain accurate and comprehensive documentation of collection activities, account adjustments, communications, and updates.
• Review submitted claims to verify reimbursement accuracy and ensure compliance with payer requirements.
• Correct and reprocess claims when necessary to optimize payment outcomes.
• Interpret Explanation of Benefits (EOB) statements to determine appropriate follow-up actions.
• Identify opportunities to improve billing and collections workflows and reduce claim denials.
• Consistently meet established quality, accuracy, and productivity objectives.

• High school diploma or GED required.
• At least 1 year of experience in home infusion or specialty pharmacy medical billing and claims processing.
• Strong customer service orientation, with the ability to communicate effectively and professionally with patients, payers, and colleagues.
• Excellent problem-solving and critical-thinking skills, particularly when investigating complex billing issues.
• Strong verbal and written communication abilities.
• Exceptional attention to detail and accuracy when reviewing claims and managing financial accounts.
• Proficiency in Microsoft 365 applications.
• Ability to work independently while contributing effectively to a collaborative team environment.
• Good understanding of medical billing workflows and reimbursement processes is preferred.
• Knowledge of ICD-10, CPT, and HCPCS coding systems is an advantage.
• Familiarity with Medicare billing requirements and reimbursement guidelines is preferred.
• Experience reviewing and interpreting payer contracts is an asset.
• Previous experience with HCN360 or CPR+ software is preferred.
• For remote work, a cable broadband or fiber-optic internet connection with minimum speeds of 10 Mbps download and 5 Mbps upload is required.

• Compensation: Competitive hourly pay ranging from $17.75 to $26 USD, depending on relevant experience and geographic location.
• Annual bonus: Eligibility to participate in an annual bonus plan.
• Healthcare coverage: Medical, dental, and vision insurance available from the first day of employment.
• Well-being support: Access to behavioral health and well-being programs.
• Retirement savings: Access to a 401(k) plan.
• Life insurance: Company-paid life insurance coverage.
• Professional development: Tuition reimbursement opportunities to support continued learning and career growth.
• Paid time off: At least 18 days of paid time off annually, plus paid holidays.
• Additional leave: Access to various leave-of-absence programs.
• Remote work: Fully remote working arrangement within the United States.
• Work schedule: Monday to Friday, with one of two scheduled shifts: 8:00 AM–4:30 PM ET or 8:30 AM–5:00 PM ET.