This role will work across various teams to ensure we are providing clear and concise information to provider users in our digital tools. The objective is to manage the mapping of data benefit and claim information that is used within the provider digital applications. This will require collaboration across internal stakeholders such as client implementation analysts and IT production support. Continuous improvement and ongoing governance of our digital tools for providers result in significant value for Cigna, our provider partners and ultimately our customers who are navigating their healthcare journey. You will own the procedure code mapping files for multiple claim systems and the corresponding audit process to ensure we continue to provide accurate benefits. If you are detail-oriented and passionate about delivering a superior experience, we'd love to have you join our team.
Create standard operating procedures and job aids for mapping files from each claim system for knowledge sharing and business continuity practices
Communicate with IT partners to support the mapping details, support the business rationale, and answer questions.
Support agile product owners as a mapping subject matter expert when program deliverables impact the benefit or claim mapping details.
Participate within the agile scrum team to articulate changes or impacts to mapping based on the program requirements and scope within defined timelines. Participate in the development and documentation of requirements, features & business acceptance criteria that accurately and completely articulate business needs for all affected personas, both internal and external and that strive to maintain or improve the provider experience with Cigna's eService mapping, which may include new tools based on program scope.
Research of production issues to determine if mapping revisions are required
Proactive communications to identify/resolve issues and clarify mapping requirements, features & business acceptance criteria throughout the delivery life cycle.
Provide feedback on test scenarios, participate in business acceptance testing or review of evidence to confirm business requirements are met. Assessment of defects for provider experience impacts and prioritization based on business needs.
Coordinate with operational readiness lead and participate in creation, review, and updating of processes to support new or changes to existing Digital Solutions mapping as a result of changes or code additions.
Participate in PI Planning Sessions, Sprints, and release checkout activities to confirm digital solutions mapping changes or code additions are implemented successfully and any issues are documented for appropriate follow-up.
Participate with Product Owner for post-production monitoring of solution quality after a successful deployment and ensure the mapping changes transition into day-to-day maintenance process.
Identify and develop relationships with business and IT partners and key stakeholders in order to maintain the active mapping.
Maintain the master files for procedure code and claim remark code mapping from all source systems.
Perform routine audits of the mapping files to proactively identify any potential issues, missing codes, or other necessary changes
Proven ability to clearly articulate the initial ask and navigate through multiple channels until completion to ensure the accuracy of the final output
Courage to work with leaders at all levels and across lines of business
Strong working knowledge of Excel and ability to manipulate large amounts of vital data is critical in this role
Strong knowledge of healthcare procedure and revenue code sets. (e.g. CPT, ADA, HCPCS)
Ability to apply knowledge of healthcare code sets to benefit mapping criteria in order to select and manage the correct benefit mapping information.
Ability to retain large amounts of data and system-specific instructions to make complex decisions.
Ability to translate proprietary claim remark codes into language that is meaningful to the provider
Solid understanding of standard IT terminology
Understand and maintain mapping documents for internal codes (reason and remark codes) to the industry standard code set value
Ability to evaluate and determine if a new Industry Standard code is needed, follow the process to have the code submitted to the industry group and provide the business justification as to why it should be added via their code set meetings.
Bachelor's degree or 3+ years in a healthcare/managed care environment
Medical claim coding certificate/experience or medical claims processing experience a strong plus
Well-versed in technology, particularly the web and the HIPAA standards for EDI transactions
Well versed in the different Industry Code Set Values
Working knowledge of Agile methodology
Computer skills required: MS Excel and other Office suite products (Outlook, Word, PowerPoint, Access)
Proven project management skills
Strong problem-solving and analytical skills, dealing with ambiguity, and influencing skills
Ability to multi-task, shifting effectively among multiple activities
Excellent organizational skills including proven ability to utilize resources, prioritize, manage and meet multiple deadlines in a highly matrixed environment
Proven ability to listen, understand and interpret information from others
Strong written and verbal communication skills; ability to speak clearly and concisely to leaders at all levels, conveying information in a manner that others can understand
Ability to represent Cigna in code set management industry standard work groups.
Regional and national travel 25%
This role requires >25% of travel. You will need to be fully vaccinated in order to travel & meet the requirements for this position.
This position is not eligible to be performed in Colorado.
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
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.