7 days old

Durable Medical Equipment (DME) Case Administrator - Work from home- eviCore

Bluffton, SC 29910
  • Job Code
Remote , Work from home, United States

The Durable Medical Equipment (DME) Case Administrator will be responsible for initiating and maintaining workflow activities for the DME Health plan product by receiving and placing inbound/outbound communications between eviCore Healthcare stakeholders and External Customers including but not limited to hospitals, physicians, and suppliers. The DME Case Administrator will receive incoming data for the Prior Authorization of Durable Medical Equipment (DME), enter the received data into a platform utilizing defined internal department processes and company protocols. The DME Case Administrator will be responsible for continual research/reading becoming well versed in our varied customers' current contract language and work process flows for multiple health plans across multiple states. The DME Case Administrator will work closely with nursing staff and the Medical Director in both the DME Prior Authorization phase as well as through the possible appeals and redeterminations phase to ensure compliance with Commercial, Medicare and State guidelines as well as identify and report any trends that become apparent.

The DME Case Administrator will house the ability to research and resolve issues pertaining to the Prior Authorization process of Durable Medical Equipment and day-to-day operational concerns using defined internal department processes and company protocols. The qualified candidate will house the ability to provide excellent customer service by handling confidential and sensitive information with discretion during communication with external and internal contacts ensuring the development of strong relationships with these stakeholders while clearly representing business needs as well as business determinations. The DME Case Administrator will possess well developed critical thinking skills with the ability to multi task and effectively communicate, in oral as well as written form, paying attention to detail including spelling and grammar while effectively transferring data, interactions and thoughts in a timely and concise manner with all stakeholders.

Minimum Education, Licensure and Professional Certification requirement:

  • High School graduate with diploma or GED
  • Certification in ICD 9, ICD 10 coding preferred
  • Associates or Bachelor's degree preferred

Minimum Experience required (number of years necessary to perform role) :

  • 2+ years of experience in a healthcare focused industry or a customer service focused industry required
  • Experience with the healthcare community,ICD-9 or ICD-10 Coding, Claims Processing, knowledge of HCPCS Codes as well as familiarity with Durable Medical Equipment preferred
  • Experience with various insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid desired

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.

Posted: 2021-06-09 Expires: 2021-07-08
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Durable Medical Equipment (DME) Case Administrator - Work from home- eviCore

Bluffton, SC 29910

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