Remote RN/LPN Clinical Program Advisor, Work Anywhere, USA (Certified Coder Required) – Connecticut

Role Description:

The Clinical Program Advisor is part of an innovative team who have overall accountability for reimbursement policy creation, maintenance, and project support. This individual will partner with many areas including Prepay, Business Operations, and other matrix partners to assist with the implementation of reimbursement policies.

As a Clinical Program Advisor, the incumbent should demonstrate critical thinking, an ability to work well in a fast paced, team-based environment, both independently and partnering with other business areas to make solid, well-informed decisions based on data and multiple inputs to achieve CPU objectives.

Provides expert content/professional leadership in relation to coding and reimbursement intent. Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives. Uses deep professional knowledge and acumen to advise others. Recognized internally as a subject matter expert.

Knowledge and experience with claims data and Cigna’s claims systems are a plus.  Advantages of this position include a positive team atmosphere, cooperative business partners and work/life balance.

Responsibilities:

• A Clinical Program Advisor is responsible for the identification of reimbursement policy opportunities, policy maintenance, and project work
• Researching competitive landscape for current industry trends, and creation of code edit strategies to align with reimbursement policies
• Evaluating the impact of industry changes, code additions, revisions, and/or deletions to associated reimbursement policy and code edits
• Review data analytics to identify and validate reimbursement policy opportunities
• Document coding logic and data requirements for matrix partners
• Author and maintain reimbursement policy language, coding, and templates
• Presenting reimbursement policy summary for applicable governance
• Be a subject matter expert (SME) on existing and new reimbursement policy topics
• Clearly communicate, be collaborative, while working effectively and efficiently with other areas

Qualifications:

• Active AAPC or AHIMA coding certification required e.g., CPC, CCS-P, CIC, or COC, with a minimum of 3 years procedure coding (HCPCS/CPT) experience required
• RN or LPN active unrestricted license required.
• Healthcare insurance claim editing/analysis background required
• Strong attention to detail to include ability to analyze claim data analytics
• Proficient at documenting necessary coding/billing requirements for code editing
• Excellent business writing skills
• Facility coding certification or billing experience a plus
• Medicare coding and/or reimbursement experience preferred
• Must be proactive, and team oriented with an ability to foster collaboration
• Value others’ perspectives for successful implementation of organizational projects
• Proven ability to prioritize multiple tasks in a fast-paced environment
• Strong communication skills to include written, oral and group presentation
• Effective analytical and problem-solving skills
• Passionate regarding quality of product
• Proficiency in Microsoft Office applications

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.

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.