9 days old

SIU-Senior Investigator/Coder-Work from Home-Cigna

Cigna
Bloomfield, CT 06002
  • Job Code
    23000481
The Case Development Team, within the Special Investigations Unit (SIU), is responsible for efficiently and accurately assessing SIU referrals through preliminary investigations to determine if allegations have merit and formulate the appropriate next steps. The preliminary investigations integrate claims investigation experience and industry knowledge with the use of data analytics to identify patterns of suspect behaviors. In addition to preliminary case investigations, this team member will also be responsible for associated prepayment claim reviews where fraud, waste or abuse (FWA) is suspected.

Responsibilities

  • Conducts comprehensive case development reviews to identify highly suspect billing behaviors and trends and formulates specific investigative next steps. The finished summary should be packaged in a manner that allows the next investigator to fully understand what actions should be taken to mitigate patient harm and financial risk to our clients, customers and Cigna.
  • Analyze data specific to allegation in order to prove/disprove allegation and ensure billing patterns are appropriate specific to the entity under review.
  • Monitor and manage open claims inventory related to cases in the medical record request edit.
  • Analyze and interpret patient medical records pertaining to FWA investigations.
  • Determines CPT, HCPCS, ICD-9/ICD-10, Revenue Codes, and DRG from medical records.
  • Compare medical records to claim information in order to determine amount and nature of billable services. Provide claim processing guidelines based on coding review.
  • Coach team on clinical and coding guidelines, provide policy updates as needed
  • Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations
  • Interface with other clinicians or business partners including internal Medical Directors

Qualifications

  • Certified Professional Coder certification required
  • 4-5 years of claims fraud experience related to medical record review
  • Bachelor's degree in criminal justice or related field or 7 years of investigative claims experience required
  • Knowledge of coding including CPT, HCPCS, ICD-9/ICD-10, Revenue Codes, and DRG.
  • Expert experience using Excel, Access, and PowerPoint 2010.
  • Ability to read and interpret complex information and explain it to others; listen actively; stay focused; identify hidden messages and draw out underlying issues
  • Aptitude to communicate simple to complex written information clearly and concisely in formal and informal documents
  • Highly organized and detail oriented
  • Ability to oversee multiple projects and changing priorities

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 annual salary of 77,700 - 129,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .

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.

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.





Posted: 2023-01-21 Expires: 2023-02-19
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SIU-Senior Investigator/Coder-Work from Home-Cigna

Cigna
Bloomfield, CT 06002

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