Coding & Reimbursement Specialist - eviCore - Work from Home

The Coding and Reimbursement Specialists will monitor and resolve coding edits inquiries/issues in a timely manner to ensure optimal claim processing and reimbursement. They will also ensure the claim system contains current and complete payment rules related to Medicaid, Medicare and Commercial guidelines.

RESPONSIBILITIES:

• Obtain approval and provide notification of claim rule changes
• Review applicable federal and state policies and regulations governing healthcare reimbursement
• Perform additional research to determine the standards applicable to coding and billing compliance with government programs
• Responsible for timely and accurate research of coding resources that update critical information and stay abreast of current coding and reimbursement policies.
• Review and analyze claims issues and other indicators of suspected fraud, waste, or abuse
• Identify necessary and potential changes to existing rules based on revised and/or retired NCDs/LCDs.
• Utilize critical thinking skills to perform concurrent review of clinical and coding rules

QUALIFICATIONS:

• High school Diploma or GED required
• Coding Certification Required (CPC, RHIA, RHIT, CCS, CCS-P, CPC-H)
• Expert knowledge in interpreting and applying NCD, LCD, MPPR, and NCCI edits
• Expert knowledge, HCPC, CPT, ICD10 codes
• 2 years experience with active coding preferred
• Proficiency with General, Molecular and Genomic Lab, preferred
• Proficiency in Radiology, Cardiology, and Ultrasound, preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 23 - 35 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.