Appeals Processing Supervisor-Medicare at Cigna in Nashville, Tennessee

Job Description:

Role Summary:

The primary objective of the Appeals Supervisor is to focus on customer and internal/external partner satisfaction with a concentration on driving improvement. This leader will provide oversight and team accountability for assigned sections business results with a focused effort on people and process to achieve results. Once cycles of learning are identified based on team / internal audits, the supervisor will address gaps timely and integrate lessons learned effectively across the operation.

The Appeals Supervisor leads the front line Appeals Section with focus on Appeals processing from receipt to close, and works to ensure all timing and quality metrics are achieved. The team consists of 10 - 15 direct reports.

The primary objective of this leader is to drive continuous improvement through a holistic and well-run inspection/remediation process. The ideal candidate will have a passion for delivering on our mission - to improve the health, well-being and sense of security of the people we serve.

Reporting Relationship:

The Appeals Supervisor position reports to the Part C Appeals Manager.

Responsibilities:

• Manages the day to day Section operations


• Responsible for oversight of triaging, processing, and coordinating Appeals for Medicare members within established timelines


• Ensures Appeals processes are consistent with organizational job aids, policies and procedures, provider contracts and compliant with CMS Medicare Compliance requirements (federal guidelines)


• Responsible for developing, maintaining, training all assigned staff; to include developing/refinement of Job Aids, and supporting Policy and Procedure development


• Responsible for scheduling Weekend/Holiday staffing requirements


• Responsible for maintaining production standards, reporting, systems utilization, training, intradepartmental coordination in an effective and quality manner


• Responsible for reviewing/validating all Level 1 and Level 2 audit finds; submitting rebuttals as required


• Responsible for identifying coordination requirements with; Peer Business level Departments Pre Cert, Utilization Management, Behavior Health, Claims and all First Down Stream Related Entity (FDR) and Market Medical Directors


• Effectively identifies and executes behavior change through education and coaching support as needed.


• Responsible for human resource management functions including hiring, check-ins, performance management, coaching, development, training and compensation


• Provides effective communication to engage and develop cross functional staff in a virtual environment


• Lead communication with corporate Medical Directors to assist in driving improvement in plan operations and reduce IRE overturns


• Ensure all cases submitted to the Independent Review Entity (IRE) include all required information and details necessary to support the uphold decision, and submitted to the IRE in a timely manner


• Processing and/or oversight of the processing of RFIs, Effectuations, Compliance Statements, Reopening's, and any other documents requested or returned from a IRE, ALJ, MAC, or Judicial Review.


• Ensure consistency in decision making through inter rater reliability


• Utilize prior IRE decisions to influence consistency in decision making at the IRE level.
  
  

Qualifications:

• High School Diploma required.


• Strong claims background and knowledge of claims processing is highly preferred


• 3+ years' experience in healthcare operations with a managed care background


• Experience managing a diverse group of functional areas is preferred.


• Experience managing in a virtual environment or across multiple locations is preferred.


• Proven ability to build relationships and influence strategy with matrix partners.


• Business Acumen: Demonstrated excellence in decision making skills, excellent communication, interpersonal and negotiation skills.


• Business Application: Ability to initiate research, plan and coordinate and organize.


• Able to effectively leverage business and organizational knowledge within and across functions..


• Written Communications: Exceptional verbal and written communication skills.


• Proven track record of relationship building and management skills within and across organizations. Able to coach direct reports to improved levels of performance.


• Experience in expense management with ability to understand service center-level and customer impacts.

• Develop Direct Reports and Others


• Courage


• Motivating Others


• Business Acumen


• Organizational Agility


• Creativity


• Innovation Management


• Managing and Measuring Work


• Measuring through Systems

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.