Enrollment/Billing Representative - Remote

Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives.

Role Overview:

As a member of the Evernorth Finance team, you will edit, bill, and collect payment on standard outstanding claims with a goal of positively impacting the company's revenue and accounts receivable balance. You will communicate opportunities for best practices based on issues identified. Enabled by a robust training curriculum, clear policies, and team support, you will contribute toward the important functions of billing and collections and contributing toward our growth strategy. To achieve our collective success, a working knowledge of the billing and collection processes and accountability for quantity and quality metrics are key expectations of the role.  

Editing –

• Review invoices against payer pricing and coding requirements

• Edit claims to payers unique billing requirements timely and accurately

• Ensure payer required documentation is on file

• Direct invoices to appropriate team member to bill when billing requirements are met

• Apply appropriate hold when billing requirements are not met

Billing -

• Review invoices against payer contracts and bill rules and correct standard and routine discrepancies timely and accurately

• Submit invoices according to payer’s required method of billing i.e. website, payer portal, software, paper etc. while following company and payer requirements

• Collaborate effectively with internal business partners as well as external payers to drive timely and accurate billings

Qualifications:

• HS diploma or GED required; Associate's degree or equivalent work experience strongly preferred

• 1+ year of billing, collections, accounts receivable experience highly preferred

• 1+ year of RX Home experience preferred

• Healthcare/insurance experience highly preferred; specialty pharmacy, pharmacy or PBM experience a plus

• PC skills including Microsoft Outlook, Excel, Word

• Self-motivated and goal-oriented

• Problem-solving skills

• Solid written and verbal communication skills

• Strong research and analytical skills

• Detail oriented and strong organizational skills

• Focus on quality and service

• Demonstrated ability to meet multiple deadlines and manage a heavy workload

• Integrity to handle sensitive or confidential information is critical