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Pennsylvania Work at Home, United States of America
Remote only
Senior Collections Specialist – Enrollment/Billing Senior Representative
Job Summary
As a Senior Collections Specialist, you play a vital role in strengthening financial performance while improving the patient experience. You bring curiosity, persistence, and compassion to complex payer challenges—ensuring claims are resolved accurately, reimbursement is timely, and patients and partners are supported every step of the way. If you thrive in problem solving and want your work to make a meaningful impact, this role offers the opportunity to grow your expertise while contributing to high‑quality, patient‑centered care.
Hours: Monday- Friday, 8:30am-5pm EST
Responsibilities
Drive timely and accurate reimbursement by actively managing pharmacy claim billing, collections, and follow‑up activities.
Resolve denied, rejected, or underpaid claims by identifying root causes and applying corrective strategies that prevent repeat issues.
Interpret explanations of benefits (EOBs) to validate reimbursement accuracy and determine next steps.
Monitor accounts receivable and take ownership of outstanding balances through persistent payer or patient outreach.
Prepare, submit, and track payer appeals within required timeframes, ensuring documentation supports favorable outcomes.
Evaluate payer rules and reimbursement guidelines to determine whether claims should be corrected, refiled, or appealed.
Ensure claim accuracy by identifying and correcting billing or submission errors that impact reimbursement.
Maintain clear, timely documentation of collection activity in patient notes and reporting tools.
Partner with teammates and leaders to identify workflow improvements that strengthen efficiency, compliance, and financial performance.
Qualifications
Required Qualifications
High school diploma or GED.
Minimum of 2 years of experience in collections, A/R, medical billing, healthcare claims, pharmacy billing, or insurance‑related collections.
Working knowledge of payer reimbursement processes including commercial, Medicare, Medicaid, self‑pay, and third‑party plans.
Ability to read and interpret explanations of benefits (EOBs) and billing correspondence.
Strong communication, organization, and problem‑solving skills with a customer‑focused mindset.
Proficiency in Microsoft 365 and electronic health or billing systems.
Preferred Qualifications
2 or more years of experience in revenue cycle operations, pharmacy billing, or collections.
Experience working with ICD‑10, CPT, HCPCS, and Medicare billing guidelines.
Knowledge of pharmacy Part D claims, CE2000, home infusion billing, and third‑party payer rules.
Experience using systems such as HCN360, CPR+, or comparable billing platforms.
About the Team
This role supports CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery organization. Together, we partner with hospitals and health systems to deliver specialty pharmacy and infusion services with precision, compassion, and expertise.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
