Audit Specialist II - CarepathRx - Remote

The Cigna Group

2d • $27 - $40 • Remote

About The Position

The Audit Specialist II facilitates the processing of audits within the parameters of the audit program. The role reviews claim submissions for accuracy, identifies root causes of claim issues, works to resolve discrepancies, and shares findings with leadership. It requires knowledge of home infusion, state and federal guidelines, and payer requirements, alongside strong communication and problem-solving skills.

Requirements

• High school diploma or GED.
• Proficiency in the Microsoft Office Suite.
• At least 3 years of experience in home infusion revenue cycle.
• Strong knowledge of federal and state billing guidelines.
• Working knowledge of basic medical terminology.
• Excellent verbal and written communication skills.
• Strong customer service orientation.
• Excellent problem-solving skills.
• Strong interpersonal and organizational skills, with the ability to manage multiple tasks simultaneously and maintain attention to detail.
• For working at home occasionally or permanently, an internet connection through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download and 5 Mbps upload.

Nice To Haves

• Experience with CPR+ Software.
• Experience with ICD-10, CPT-4, HCPCS, and Medicare billing.

Responsibilities

• Prioritize and complete assigned tasks.
• Complete payer audits in a timely manner and before deadlines.
• Maintain current knowledge of state and federal guidelines and payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan.
• Perform quarterly quality audit checks.
• Complete quality audits for new employees until they meet the accuracy threshold.
• Perform claim denial audits.
• Complete ongoing quality focus audits on billing and collection activity.
• Assist with training on recurring errors identified during quality audits.
• Assist in developing Standard Operating Procedures.
• Complete special projects as requested.
• Perform in accordance with system-wide competencies and behaviors.

Benefits

• Medical, vision, and dental benefits.
• Well-being and behavioral health programs.
• 401(k).
• Company-paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year.
• Paid holidays.
• Leaves of absence.
• Anticipated eligibility to participate in an annual bonus plan.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED