[Hiring] Audit Specialist II @The Cigna Group

Role Description

The Audit Specialist II is responsible for facilitating processing of audits within the parameters of the audit program. The role involves reviewing claim submissions for accuracy, identifying root causes of claim issues, with the goal of resolving discrepancies and sharing findings with leadership. The ideal candidate will have knowledge of home infusion, state and federal guidelines, and payer requirements, as well as strong communication and problem-solving skills.

• Effectively prioritize and complete all assigned tasks
• Complete payer audits in a timely manner and before deadlines
• Maintain a current knowledge base of state and federal guidelines, and payer requirements, including but not limited to, Medicare, Medical Assistance, Highmark and UPMC Health Plan
• Perform quarterly quality audit checks
• Complete quality audits on new employees until 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 development of Standard Operating Procedures
• Complete special projects as requested
• Perform in accordance with system-wide competencies/behaviors

Qualifications

• 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

Requirements

• 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

Benefits

• Hourly rate of 27 - 40 USD / hourly, depending on relevant factors, including experience and geographic location
• Eligible to participate in an annual bonus plan
• Comprehensive range of benefits, with a focus on supporting your whole health
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays
• Leaves of absence

Company Description

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.