The posting
Make an Impact Through Every Claim Resolved
At CarepathRx, we help health systems and hospitals deliver pharmacy care that supports better patient outcomes. As a Medical Collections Specialist, you will help resolve insurance claims, improve reimbursement, and support a smoother experience for patients, payers, and care teams. This is a great opportunity for someone who is detail-oriented, curious, and ready to grow in revenue cycle work. Home infusion billing or collections experience is strongly preferred because it supports success in this specialized care setting. You will join a team of ambitious and compassionate experts who solve problems, learn together, and take pride in doing work that matters.
Schedule: Monday-Friday, 8:00 a.m.-4:30 p.m. ET
Responsibilities
- Support strong reimbursement outcomes by collecting on insurance claims and moving unpaid accounts toward timely resolution.
- Research denials, rejections, and payment issues to find root causes and recommend steps that help prevent repeat problems.
- Submit payer appeals within required time frames and use clear documentation to support accurate claim review.
- Review patient account details, claim status, and explanations of benefits to decide the best next action, such as correction, refiling, adjustment, or appeal.
- Investigate claims and payer contracts to confirm payment accuracy and identify reimbursement gaps, with attention to home infusion billing requirements when applicable.
- Communicate with patients, payers, outside agencies, and internal partners in a professional, helpful, and timely manner.
- Document collection activity, account actions, and outcomes in patient notes, AR Aging Reports, and Over/Under Reports.
- Track account trends and share insights that support process improvements, stronger collections, and better revenue cycle results.
- Meet quality, productivity, and service standards while working independently and as part of a collaborative team.
Required Qualifications
- High school diploma or GED.
- 1+ year of experience in medical collections, medical billing, revenue cycle, healthcare administration, or a related role.
- Experience working with insurance claims, denials, appeals, payer follow-up, or account resolution.
- Ability to read and interpret an explanation of benefits (EOB) and understand claim payment or denial activity.
- Knowledge of insurance policies, third-party payer guidelines, and reimbursement practices.
- Strong customer service, communication, organization, and problem-solving skills.
- Ability to communicate clearly by phone, email, and written correspondence with patients, payers, and internal partners.
- Strong attention to detail and ability to manage multiple priorities in a fast-paced environment.
- Ability to handle sensitive information with care, discretion, and confidentiality.
- Ability to perform basic math calculations and review account data accurately.
Preferred
- Strongly preferred: 1+ year of experience in home infusion billing, home infusion collections, specialty pharmacy, or a closely related healthcare setting.
- 2+ years of experience in medical collections, medical billing, revenue cycle, or healthcare financial operations.
- Experience working with insurance claims, denials, appeals, payer follow-up, or account resolution.
- Working knowledge of ICD-10, CPT, HCPCS, and medical terminology.
- Familiarity with Medicare billing requirements, including DMEMAC guidelines.
- Experience with HCN360, CPR+, or similar healthcare billing systems.
- Associate or bachelor's degree in healthcare administration, business, finance, or a related field.
- Knowledge of financial resources or payment assistance options that support patient account resolution.
CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. Drug-free work environment. Must be eligible to work in this country.
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.
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 [email protected] 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.
