Auto-Recoupment Integration (Payment Integrity) - Cigna Healthcare - Remote (Finance)

Description

This position is responsible for supporting Cigna's vendor overpayment auto recoupment program and will report through the Payment Integrity, Overpayment Vendor Management organization. Individual will perform as a Subject Matter Expert, working with external vendors, providers and internal matrix partners to monitor process, respond to inquiries and ensure maximum effectiveness and efficiency throughout the lifecycle of the process.

Role Responsibilities

• Obtain various documentation needed to support overpayment auto recoupment activities (DDARs, vendor refund Notice Letters, negative balance reports, EOPs, provider contracts)
• Respond to providers, vendors and internal matrix partners on auto-recoupment inquiries.
• Research and seek resolution on various issues from daily report on auto recoupment. Collaborate with multiple business and technical teams.
• Prepares vendor training materials, conducts auto-recoupment training and monitors vendor quality.
• Create internal SOPs and works closely with Claim, Call and Network organizations on vendor overpayment auto recoupment processes, reporting, etc.
• Perform all cancellations from vendors on auto recoupments until automated and work with areas to get resolved if they cannot be cancelled.
• Research claim status issues including "on hold, cancellations and expired" within claim platforms and auto-recoupment interface sources.
• Prepare adhoc reporting on auto recoupment as requested
• Partner with Contracting and vendors ondifficult provider collection issues.
• Identify performance trends and recommend improvement opportunities to management.

Qualifications

• Bachelor's Degree or higher strongly preferred or equivalent work experience required
• 2+ years of advanced proficiency in Proclaim and or Facets required
• Expert in claim payment and financial understanding highly preferred
• Strong proficiency with SharePoint, Webex Meetings, Microsoft Word, Excel, Outlook, and PowerPoint.
• Banking knowledge preferred (DDAR and 835)
• Excellent verbal and written communication skills, with the ability to convey complex technical concepts to non-technical audiences.
• Demonstrated ability to work collaboratively with diverse teams and foster a collaborative environment.
• Icatch (CORS) knowledge preferred
• High level understanding of OPR Refund Process Preferred
• Ability to react to issues with appropriate sense of urgency

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 63,500 - 105,800 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 Group .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

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.

The Cigna Group 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.