Remote Audit Specialist II - Payer Compliance & QA

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 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.