Job type full-time
Full job description
This position is responsible for conducting pharmacy claim audits to ensure compliance and accuracy of the assigned business areaAs a member of the post pay quality and assurance monitoring internal monitoring team, the incumbent will have the ability and is expected to identify issues, drive change, and positively affect the accuracy and efficiency of cigna and esi operations by recommending actions that address error trends and root-causes of errors found during quality audits.
Complete assigned audits in a timely manner
Follow up and respond to inquiries from the auditee regarding audit work performed
Identify and report error trends to management
Work with management in developing appropriate remediation steps to address audit findings and error trends
Train other auditors and create job aids and other related material for the ops internal monitoring department
Develop subject matter expertise in areas audited and become resource for the team
Ability to meet production demands and maintain a high level of qualityThis may include occasional overtime, especially during the peak seasons
Supports and drives process improvement to further enhance service outcomes; opportunities for streamlining processes and procedures, reducing rework
Supports and reinforces updated and/or new information; sops, tools, system enhancements, workflows, etc.
Other duties as assigned
Pharmacy technician certification (cpht) desired (state or national)
Knowledge of pharmacy claims processing, including multi-ingredient compounds or special adjudication rules
Knowledge of cms guidance of mapd, part d plans, and special needs care plan
Working knowledge of microsoft word & access, sharepoint, and lync, with intermediate proficiency level of excel.
Experience in quality review/auditing
Skilled in analyzing quality results
Proven confidence in the usage and application of all tools, workflows, and processes in current role
Minimum 3 years’ experience in a managed care or related field
Possess an understanding of operational and compliance auditing
Exceptional verbal and written communication skills
Work remotely, independently and with the team with minimal oversight and supervision
Ability to meet strict timelines
Strong interpersonal skills to work with many different personalities and styles
Capable of explaining complex issues in a concise manner
This role is wah/flex which allows most work to be performed at homeEmployees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in colorado.
Cigna corporation exists to improve livesWe are a global health service company dedicated to improving the health, well-being and peace of mind of those we serveTogether, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millionsThrough our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovationWhen you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s livesWhat 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: firstname.lastname@example.org for supportDo not email email@example.com for an update on your application or to provide your resume as you will not receive a response.