Collections Specialist II, Home Infusion

Job Summary

The Collections Specialist II is responsible for managing insurance collections, resolving claim denials, processing appeals, and ensuring accurate and timely reimbursement. This role requires experience in medical billing, payer guidelines, and accounts receivable management, with a focus on identifying and resolving payment issues. Knowledge of home infusion and healthcare reimbursement processes is preferred.

Responsibilities

• Manage third-party billing and collections activities.
• Investigate and resolve claim denials, rejections, and underpayments.
• Submit payer appeals and monitor timely follow-up.
• Review claims, EOBs, and patient accounts to determine appropriate next steps.
• Correct and reprocess claims for reimbursement when necessary.
• Document collection efforts and actions taken on accounts.
• Communicate with payers, patients, and internal teams to resolve outstanding balances.
• Maintain quality, productivity, and compliance standards.
• Perform other duties as assigned.

About the Role

This position supports CarepathRx within Evernorth Health Services and focuses on specialty pharmacy and infusion services. The work is centered on improving patient outcomes through effective reimbursement and collections management.