Claims Analyst, Coding and Reimbursement Specialist - eviCore - Remote

Do you want to improve the health and vitality of those we serve? EviCore a line of business within the Cigna Group, is hiring a Coding and Reimbursement Specialist, Claims Analyst. As a certified coder, you’ll monitor and resolve coding edits, inquiries and/or issues in a timely manner. You’ll ensure optimal claim processing and reimbursement and that the claim system contains current and complete payment rules related to Medicaid, Medicaid, and Commercial guidelines.

What you’ll do to make a difference:
• Obtain approval and providing 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 current with new 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.
• Utilizes critical thinking skills to perform concurrent review of clinical and coding rules

Requirements: • High school diploma or GED, required • Coding Certification, Required (CPC, RHIA, RHIT, CCS, CCS-P, CPC-H) • Proficient with multi-Specialty Programs, such as Molecular and Genomic Lab, General Lab, Radiology, Cardiology and/or Ultrasound, strongly preferred • 2+ years of active coding experience, required • Proficient with coding guidelines and coding resources (i.e. encoder pro), required • Proficient with all Microsoft applications (Excel, Word, Outlook), required • Ability to analyze and interpret data, strongly preferred • Expert knowledge in interpreting and applying NCD, LCD, MPPR, and • NCCI edits, strongly preferred • Strong interpersonal skills both written and oral, required • Expert knowledge, HCPC, CPT, ICD10 codes, required

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 Group.

About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

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.

The Cigna Group 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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