Certified Program Management Advisor, Reimbursement Policy - Remote

POSITIOIN SUMMARY

The Program Management 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.

The Program Management Advisor will 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 business 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.

Candidates who reside within 50 miles of the following locations may be required to perform onsite 3 days per week: Bloomfield, CT; Chattanooga, TN; Denver, CO; St Louis, MO; and Scottsdale, AZ.

Primary Responsibilities


* Execute responsibility for the identification of reimbursement policy opportunities, policy maintenance, and project work associated with the policies


* Detailed research for the competitor landscape to identify current industry trends, and creation of code edit strategies to align with reimbursement policies


* Manage the policy maintenance for evaluation of industry changes, code additions, revisions, and/or deletions associated with reimbursement policy and code edits


* Execute the ability to review data analytics to identify and validate reimbursement policy opportunities


* Maintain and document clear coding logic and data requirements for matrix partners


* Author and maintain reimbursement policy language, coding, and templates


* Present reimbursement policy summary for applicable governance


* Become the subject matter expert (SME) on existing and development of new reimbursement policy


* Execute clear communication, be collaborative, while working effectively and efficiently with other matrix partners

Key Qualifications


* Bachelor's degree in Healthcare, Nursing or related curriculum preferred


* Active AAPC or AHIMA coding certification required e.g., CPC, CCS-P, CIC, or COC, with a minimum of 5 years procedure coding (HCPCS/CPT) experience required


* At least 5 years' 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


* Exce...