Coding and Reimbursement SME - Work from home - eviCore at Cigna in Memphis, Tennessee

Job Description:

The Coding and Reimbursement SME. The SME will provide analysis of the most complex claim rule issues by applying research, coding standards, industry knowledge and federal regulations to ensure correct coding practices. In this role, the SME will perform reviews to identify trends related to claim rules and edits as well as monitor for accuracy and compliance. Provide general support to team members, serving as a resource and subject matter expert (SME).The candidate will be responsible for:

• Assist management in the daily operations and processes within the department.


• Individually lead the coders on projects to ensure deliverables align to coding/billing standards


• Design and participate in the clinical and coding education of coders,and physicians. This includes training and mentoring of new and existing staff.


• Monitors turnaround times for multiple applications and provides suggestions for process efficiencies.


• Uses independent decision making skills to review claim rule issues and inquiries to meet deadlines.


• Apply coding and clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult claim rule issues


• Review and analyze claims issues and other indicators of suspected fraud, waste, or abuse


• Identify necessary and potential changes to existing rules based on revised and/or retired NCDs/LCDs.


• Utilizes critical thinking skills to perform concurrent review of clinical and coding rules

Qualifications:

• Proficient with one or more of the following Multi-Specialty Programs
  
  
  • Molecular and Genomic Lab
  
  
  • General Lab
  
  
  • Radiology/Cardiology/Ultrasound
  
  
  • Radiopharmaceuticals
  
  
  • Sleep Management
  
  
  • DME
  
  
  • Medical Oncology
  
  
  • Radiation Therapy
  
  
  • Fertility
  
  
  • Physical/Occupational/Speech Therapies
  
  
  • Spine, Pain, and Joint Surgeries
  
  
  
  


• 3 years active coding experience


• 2 Years Medical Coding/Billing Instructor experience preferred


• Proficient with coding guidelines and coding resources (i.e. encoder pro)


• Proficient with all Microsoft applications


• Ability to analyze and interpret data


• Expert knowledge in interpreting and applying NCD, LCD, MPPR, and NCCI edits


• Strong interpersonal skills both written and oral.


• Expert knowledge, HCPC, CPT, ICD10 codes

Requirements:

• High school Diploma or GED required

• Coding Certification Required (CPC, RHIA, RHIT, CCS, CCS-P, CPC-H)

This role is Flex/WFH which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Cigna

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.

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