[Hiring] Medical Collections Specialist @The Cigna Group

Role Description

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.

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.

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.

Requirements

• 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.

Benefits

• 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.
• Encouragement for local applicants to apply.
• Drug-free work environment.
• Must be eligible to work in this country.
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload if working from home.