Medical Billing and Claims Specialist: Role Overview and Responsibilities

Evernorth, a health services company under The Cigna Group, is hiring for a remote Medical Billing Specialist position based in Florida. The role focuses on the review and billing of medical and National Council for Prescription Drug Programs (NCPDP) claims to resolve billing discrepancies and maximize reimbursement.

The recruitment is part of a broader effort within The Cigna Group’s customer service and claims divisions to manage pharmacy and medical billing workflows. According to the job specifications, the specialist is responsible for identifying and resolving claim rejections to ensure accurate financial processing.

This remote opportunity allows Florida-based professionals to handle complex billing cycles without reporting to a physical office, reflecting a shift toward distributed workforces in the healthcare administration sector.

Core Responsibilities of the Medical Billing Specialist

The primary function of the role is the oversight of medical and NCPDP claims. This involves a technical review process to ensure that billing codes and patient data align with payer requirements.

Specific duties include the following:

• Reviewing and billing medical and NCPDP claims.
• Identifying the root causes of claim rejections.
• Resolving billing discrepancies to prevent payment delays.
• Implementing strategies to maximize reimbursement rates.

The mention of NCPDP standards indicates the role requires familiarity with the pharmacy-specific data exchange standards used by pharmacies and payers to process prescriptions.

Organizational Context within The Cigna Group

Evernorth operates as a primary arm of The Cigna Group, focusing on pharmacy benefit management and health services. By placing this role within the Customer Service and Claims division, the company integrates billing accuracy with patient and provider satisfaction.

The integration of medical billing with NCPDP claims suggests a cross-functional approach where the specialist must navigate both traditional medical billing and the specialized requirements of pharmacy claims processing.

The remote nature of the position for Florida residents indicates a targeted recruitment strategy to attract talent within a specific regulatory and geographic region while maintaining a virtual operational model.