Audit Specialist II

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $27 - $40 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Prioritize and complete all assigned tasks • Complete payer audits in a timely manner and before deadlines • Maintain current knowledge of state and federal guidelines and payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan • Perform quarterly quality audit checks • Complete quality audits on new employees until the accuracy threshold is met • Perform claim denial audits • Complete ongoing quality focus audits on billing and collection activity • Assist with training on recurring errors found during quality audits • Assist in developing Standard Operating Procedures • Complete special projects as requested • Perform in accordance with system-wide competencies and behaviors • Review claim submissions for accuracy and identify root causes of claim issues • Resolve discrepancies and share findings with leadership

🎯 Requirements

• High School diploma or GED required • Proficiency in the Microsoft Office Suite • 3+ years of experience in home infusion revenue cycle • Strong knowledge of Federal and State billing guidelines • Working knowledge of basic medical terminology required • Excellent verbal and written communication skills • Strong customer service orientation • Excellent problem-solving skills • Strong interpersonal and organizational skills, with the ability to work on multiple tasks simultaneously with attention to detail • Experience with CPR+ Software • Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred • Home internet connection through a cable broadband or fiber optic internet service provider, with speeds of at least 10Mbps download/5Mbps upload, if working from home

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work option • Cable broadband or fiber optic internet requirement for home working, with at least 10Mbps download/5Mbps upload

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