Audit Specialist II - CarepathRx - Remote

Cigna Healthcare; Oregon; Hybrid; USD 37,000 - 55,000; Full time

Job summary

The Cigna Group is seeking an Audit Specialist II to facilitate audits within the audit program, reviewing claim submissions for accuracy and identifying root causes of issues. The role emphasizes home infusion knowledge, state and federal guidelines, and payer requirements, with strong communication and problem-solving skills.

Responsibilities include prioritizing tasks, completing payer and quality audits, training on recurring errors, and contributing to SOP development.

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.
• 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.
• Complete payer audits in a timely manner and before deadlines.
• Maintain a current knowledge base of state and federal guidelines, and payer requirements.
• 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.

Skills

Communication skills

Customer service

Problem-solving

Organizational skills

Multitasking

Education

High School diploma or GED

Tools

Microsoft Office Suite

CPR+ Software

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. 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here .

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.

If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.