United States Remote, Work from House
High speed web is a requirement to be able to perform this function
The Coding and Repayment Expert will guarantee our Claim System consists of existing and total payment guidelines. Claim payment guidelines consist of, however are not restricted to, bundling guidelines; alternative guidelines; right coding guidelines and specific claim policies and treatments. This person will likewise be accountable for getting approval and supplying notice of guideline modifications to the suitable celebrations.
This position needs working carefully with eviCore Medical Directors, Customer Relations, Claims Setup, the Claim Studio Application Group and Management to guarantee guideline modifications are prompt, precise, completely checked in the Claims System, well recorded and interacted.
Other duties consist of:
Evaluation appropriate federal, state, and industrial policies and policies governing health care compensation.
Carry out extra research study to figure out the requirements appropriate to coding and billing compliance with federal government programs.
Evaluation and examine claims problems associated with recognizing possible claim guidelines mistakes, disparities, abnormalities, unusual patterns and other signs of presumed scams, waste, or abuse.
End up being subject professional( SME) for designated program/client.
Conduct service provider and medical education associated to coding standards.
Identify needed and possible modifications to existing guidelines based upon modified and/or retired policies and the addition of brand-new policies
Accountable for prompt and precise research study of resources that upgrade important info on a set up basis.
Stay abreast of present coding and compensation problems.
Help with training for other staff member associated with coding.
Work together with management and program directors on supplier training, instructional in-services and acts as a very first line resource for coding concerns connected to designated program.
Helps with extra tasks as appointed.
Minimum Education, Licensure and Specialist Accreditation requirement:
Bachelor’s Degree or comparable work experience of a minimum of 5 years in health care associated field
Coding Accreditation Required (e.g., CPC, RHIA, RHIT, CCS, CCS-P, CPC-H)
Minimum Experience needed (variety of years required to carry out function):
5 years previous health care or medical market experience associated to coding, billing, insurance coverage billing guidelines and guidelines
Competent with several of the following Multi-Specialty Programs
Molecular and Genomic Laboratory
General Laboratory
Radiology/Cardiology/Ultrasound
Radiopharmaceuticals
Sleep Management
DME
Medical Oncology
Radiation Treatment
Fertility
Physical/Occupational/Speech Treatments
Spinal Column, Discomfort, and Joint Surgeries
3-5 years dealing with numerous state federal government health insurance
3-5 years as a licensed coder with non-apprentice status
3 years active coding experience
2 years prior medical insurance, Medicaid/Medicare claims processing consisting of ICD, CPT, HCPCS, LCD’s and NCD’s, and Articles
2 years experience dealing with bundling and NCCI edits
3 years working straight with CMS and Medicare standards
Skilled with electronic coding resources (i.e. encoder pro)
Required Abilities:
Well arranged, information oriented.
Able to work separately with very little instructions
Strong social abilities both composed and oral.
Professional understanding, HCPC, CPT, ICD10 codes
Skilled with Outlook Excel, Word and Gain Access To
Capability to evaluate and translate information
Specialist understanding of Commercial, Medicare and Medicaid Compensation Policies and Resources
Professional understanding in translating and using NCD, LCD, MPPR, and NCCI edits
This position is not qualified to be carried out in Colorado.
About Cigna
Cigna Corporation exists to enhance lives. We are a worldwide health service business committed to enhancing the health, wellness and comfort of those we serve. Together, with coworkers worldwide, we desire change health services, making them more budget friendly and available to millions. Through our unrivaled proficiency, vibrant action, fresh concepts and an undeviating dedication to patient-centered care, we are a force of health services development. When you deal with us, or among our subsidiaries, you’ll delight in significant profession experiences that enhance individuals’s lives. What distinction will you make?
Certified candidates will be thought about without regard to race, color, age, impairment, sex, giving birth (consisting of pregnancy) or associated medical conditions consisting of however not restricted to lactation, sexual preference, gender identity or expression, veteran or military status, faith, nationwide origin, origins, marital or familial status, hereditary details, status with regard to public help, citizenship status or any other particular secured by suitable equivalent job opportunity laws.
If you need sensible lodging in finishing the online application procedure, please e-mail: SeeYourself@cigna.com for assistance. Do not email SeeYourself@cigna.com for an upgrade on your application or to supply your resume as you will not get an action.
Cigna.
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