Audit Specialist II - CarepathRx - Remote

Cigna Healthcare; New York (NY); Remote; USD 37,000 - 55,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Well-being programs

401(k)

Life insurance

Tuition reimbursement

18 days paid time off per year

Paid holidays

Leaves of absence

Job summary

The Cigna Group is hiring an Audit Specialist II to facilitate audits within the approved program, review claim submissions, identify root causes, and resolve discrepancies. The role requires knowledge of home infusion, payer requirements, and strong communication skills.

You will prioritize tasks, conduct quality audits, assist in SOP development, and support training. This remote-friendly role offers potential annual bonus and a salary of 27–40 USD per hour, with comprehensive benefits.

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.

Responsibilities

• Prioritize and complete all assigned tasks efficiently.
• Complete payer audits promptly before deadlines.
• Maintain knowledge of state and federal guidelines and payer requirements.
• Perform quarterly quality audit checks.
• Audit new employee performance until accuracy threshold is met.
• Conduct claim denial audits.
• Carry out ongoing quality focus audits on billing and collection activity.
• Assist with training on recurring errors found during audits.
• Assist in developing Standard Operating Procedures.
• Complete special projects as requested.
• Adhere to system-wide competencies and behaviors.

Skills

Verbal communication

Written communication

Customer service

Problem solving

Interpersonal skills

Organizational skills

Attention to detail

Microsoft Office

CPR+ Software

ICD-10/CPT-4/HCPCS/Medicare billing

Education

High School diploma or GED

Tools

CPR+ Software

Microsoft Office Suite

Job 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.

What you’ll do to make a difference:

• 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

What you need to be successful:

• 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.

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 27 - 40 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.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• minimum of 18 days of paid time off per year
• paid holidays
• leaves of absence

About The Cigna Group

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.

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.

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.