Audit Specialist II

🔥 0 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Facilitate processing of audits within the parameters of the audit program • Review claim submissions for accuracy • Identify root causes of claim issues • Resolve discrepancies and share findings with leadership • Prioritize and complete assigned tasks • Complete payer audits 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 • Audit new employees until the accuracy threshold is met • Perform claim denial audits • Conduct 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

🎯 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 cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload if working from home • Candidates in applicable states who use tobacco/nicotine must enter a qualifying smoking cessation program before employment

🏖️ 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 • Tobacco-free policy

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