Job Description

Do you have a passion for purpose? Want to Drive Growth and Improve Lives? EviCore, a division of The Cigna Group is hiring a Coding and Reimbursement Specialist. As a CERTIFIED CODER, you\'ll will ensure our Claim System contains current and complete payment rules. Claim payment rules include, but are not limited to, bundling rules; substitution rules; correct coding rules and certain claim policies and procedures. You\'ll be responsible for obtaining approval and providing notification of rule changes to the appropriate parties. You\'ll collaborate with eviCore Medical Directors, Client Relations, Claims Configuration, the Claim Studio Implementation Team and Leadership to ensure rule changes are timely, accurate, thoroughly tested in the Claims System, well documented and communicated.

How you\'ll make a difference:

• Perform additional research to determine the standards applicable to coding and billing compliance with government programs.
• Review and analyze claims issues related to identifying possible claim rules errors, inconsistencies, anomalies, abnormal patterns and other indicators of suspected fraud, waste, or abuse.
• Conduct provider and clinical education related to coding guidelines.
• Identify necessary and potential changes to existing rules based on revised and/or retired policies and the addition of new policies
• Review applicable federal, state, and commercial policies and regulations governing healthcare reimbursement.
• Responsible for timely and accurate research of resources that update critical information on a scheduled basis.
• Stay abreast of current coding and reimbursement issues.
• Be the SME and assist with training of other team members
• Collaborate with management and program directors on provider training, educational in-services and serves as a first line resource for coding questions related to assigned program.

What you\'ll need to be successful:

• High school Diploma or GED required
• Coding Certification required (e.g., CPC, RHIA, RHIT, CCS, CCS-P, CPC-H)
• 3+ years of experience as a certified coder with non-apprentice status
• 5+ years of experience in healthcare or medical industry experience related to coding, billing, insurance billing rules and regulations, required
• 3+ years of experience working with multiple state government health plans
• 2+ years prior health insurance, Medicaid/Medicare claims processing including ICD, CPT, HCPCS, LCD\'s and NCD\'s, and Articles required
• Expert knowledge, HCPC, CPT, ICD10 codes required
• Expert knowledge in interpreting and applying NCD, LCD, MPPR, and NCCI edits required
• 2+ years of experience working with bundling and NCCI edits
• 3+ years of experience working directly with CMS and Medicare guidelines
• Proficient with one or more of the following Multi-Specialty Programs; Molecular and Genomic Lab, General Lab, Radiology/Cardiology/Ultrasound , Radiopharmaceuticals, Sleep Management, DME, Medical Oncology, Radiation Therapy, Fertility, Physical/Occupational/Speech Therapies, Spine, Pain, and Joint Surgeries
• Proficient with electronic coding resources (i.e. encoder pro) required
• Tech savvy and proficient with Microsoft office products (Word, Outlook, Excel) required

What you\'ll love about working here:

• 1st day benefits - Medical Dental & Vision and more
• 18 days Paid Time Off & 8 Paid Holidays
• Caregiver leave
• Annual Merit increases
• Annual bonuses
• Employer Contributions for HRA and HSA accounts
• 401K with Company Match
• Tuition Assistance
• Advancement opportunities

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

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