We are a global health company, focused on improving the health and vitality of those we serve. Through our two divisions, Cigna HealthcareSM and Evernorth Health Services®, we are committed to enhancing the lives of our clients, customers, and patients.
Healthcare Credentialing Specialist
About the job
Job Title: Healthcare Credentialing Specialist
Pay Rate: $22/Hour on W2
Start: 11/11/2024-End: 03/31/2025 {Possibility of an extension}
Hours Per Week: 40.00
Hours Per Day: 8.00
Duties:
Delivers professional activities in the Client Services job family. Responsible for providing client support in the areas of service, maintenance and penetration. Responds to inquiries, solving problems, and ensuring client satisfaction with products and service. Coordinates with account manager to ensure needs are met and potential problems are averted. Keeps account manager informed of account status and opportunities for expanded business. May make on-site presentations to existing and prospective clients to educate and inform on products. Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial reports/analyses for review. May provide guidance, coaching, and direction to more junior members of the team in Client Account Support.
2 year minimum of data entry experience
Credentialing/Licensing/Contracting experience preferred, but not required
Attention to detail
Independent Worker
Intermediate PC Skills
Intermediate proficiency with Microsoft Office Products
WPM included on resume is encouraged but not required
Excellent written and verbal communication skills
Excellent time management skills
Education:
HS Diploma or GED equivalent
Healthcare Regulatory Compliance Analyst
About the job
Job Title: Healthcare Legal Compliance Associate Analyst
Location: Remote (supporting EST schedule)
Start Date: 11/18/2024
End Date: 12/31/2024
Pay Rate: $23/hr on W2
Schedule and Work Environment:
- Schedule: Monday – Friday, 8:00 AM – 5:00 PM EST
- Training Schedule: Same as regular working hours
- Work Environment: 100% remote; candidates must ensure a quiet, private workspace suitable for remote work.
Job Description:
As a Legal Compliance Associate Analyst with The Cigna Group, you’ll contribute to the Compliance team by supporting a range of legal and regulatory tasks in a fully remote role. This position requires a candidate with strong analytical and organizational skills to address state and federal legislative and regulatory issues impacting the company’s products and services. The ideal candidate is meticulous, independent, and eager to learn and grow within a dynamic environment.
Key Responsibilities:
- Regulatory Compliance Support: Assist in addressing routine legislative and regulatory issues at state and federal levels that impact Cigna’s products, practices, and administration.
- Database and Document Maintenance: Establish and maintain regulatory databases and instructional materials to support various teams.
- Technical Consultation: Provide technical support for case-specific regulatory language creation and approvals as needed.
- Documentation and Reporting: Compile, communicate, and maintain process documents, completing required documentation to meet specific quality and timeliness targets.
- Coordination and Prioritization: Work independently to prioritize tasks, ensuring alignment with deadlines, with frequent oversight from senior compliance professionals.
Required Skills and Qualifications:
- Education: Associate’s degree preferred or equivalent (3-5 years of relevant work experience).
- Experience: 2-3 years in a compliance, regulatory, or similar support role, preferably with privacy compliance experience.
- Technical Skills: Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and strong computer literacy.
- Analytical Skills: Keen attention to detail, and ability to analyze and interpret regulatory information accurately.
- Self-Starter: Ability to work independently, prioritize work effectively, and thrive in a dynamic environment.
- Remote Work Experience: Prior experience working in a remote environment with a quiet and private workspace.
- Additional Skills: Strong communication skills, eagerness to learn and grow within the compliance field, and familiarity with regulatory terminology (preferred).
Healthcare Customer Service (Grievances & Appeal)
About the job
Job Title: Customer Service Lead Representative
Duration: 2 Months possible extension
Location: 100% Work from Home (WAH)
Pay : $17
Schedule & Training
- Training: Monday – Friday, 8:00 AM – 5:00 PM CST
- Post-Training Schedule: Flexible shifts available Monday – Friday, between 8:00 AM – 5:00 PM CST; candidates can choose their shifts after completing training
- Overtime (OT): Available after training, based on performance and upon approval
Important Notes
- Location Flexibility: Candidates must be able to support CST schedules and have reliable high-speed internet in a quiet, private environment.
- Time Off Policy: Time off will not be granted in the first 8 weeks. Candidates with prior time-off commitments during this period will not be eligible.
- Punctuality: Daily on-time attendance is required.
Performance Standards
- Daily Cases: Target of closing 10 cases per day
- Quality Metric: Maintain a 95% or higher audit score
- DPA % (Direct Productive Activity): 75% or higher
Job Responsibilities
The Grievance Team manages grievances for Medicare/Medicaid members regarding the authorization and delivery of clinical and non-clinical services. This role requires collaboration across departments to ensure timely and compliant resolutions.
- Grievance Coordination: Process Medicare customer grievances, including intake of oral or written complaints, conducting root cause analysis, creating action plans, and documenting cases within CMS guidelines.
- Communication: Correspond with members, providers, and regulatory agencies to inform on case decisions and actions.
- Collaboration: Work closely with Claims, Customer Service, Appeals, and Medical Management Departments.
- Compliance: Adhere to all Compliance/Program Integrity requirements and HIPAA Regulations.
- Professional Development: Engage in mandatory and continuing education, supporting the department and organizational goals.
Skills & Requirements
Top Skills:
- Strong written communication
- Critical thinking
- Microsoft Office proficiency
Qualifications:
- Experience: Minimum of 1 year in Appeals and Grievances (A&G) or 1+ year in Customer Service within a health insurance company.
- Preferred Experience: Bilingual in Spanish.
- Additional Skills: Effective verbal communication, time management, priority setting, problem-solving, and organizational skills.
- Healthcare Knowledge: Familiarity with healthcare delivery systems and terminology, ideally with experience in managed care.
- Caseload Management: Ability to handle high caseloads efficiently using Grievance tracking systems.
- Work Setting: Previous remote work experience is preferred.
- Education: High school diploma with 2 years in Medicare or Medicaid managed care, focusing on Grievances.
Risk Adjustment Coding Auditor- Remote- Cigna Healthcare
Core Responsibilities:
- Performs monitoring of Cigna Medicare coders & vendors in order to ensure quality metrics are achieved.
- Researches IRR disagreements with the purpose of providing substantive feedback to coders.
- Meets fluctuating production demands in order to reach sampling targets.
- Maintains a high level of quality, as set by internal standards, to ensure continued auditor accuracy.
- Stays up-to-date with current Cigna Medicare coding guidelines.
- Maintains coding credentials & CEUs.
- Proficiently functions in a virtual collaborative environment.
- Participates in regular team and company meetings.
Minimum Qualifications:
- Must possess an active professional coding credential through AHIMA or AAPC (required).
- Minimum 2-5 active years of experience as a medical coder (required).
- Experience with HCC coding (required).
- Extensive knowledge of CMS guidance of Risk Adjustment & ICD-10 CM diagnosis guidelines (required).
- Extensive knowledge of medical terminology, anatomy and physiology (required).
- Knowledge of pathophysiology and pharmacology (preferred).
- Extensive knowledge of Medicare and HIPAA regulations and guidelines (required).
- Excellent written and oral communication skills (required)
- Basic proficiency in Excel (required).
- Knowledge of Microsoft Word & Outlook (required).
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 21 – 32 USD / hourly, depending on relevant factors, including experience and geographic location.