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

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 annua...