Cigna Medicare Clinical Operations Intake Care Senior Representative Precertification - Remote, United States - The Cigna Group

Description

The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization. The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.

Essential Duties and Responsibilities:

• Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal
• Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
• Determine authorization requirements based on company policy, member benefit grid and provider status
• Review customer coverage and benefits
• Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
• Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
• Professional demeanor and the ability to work effectively within a team or independently
• Flexible with the ability to shift priorities when required
• Maintains regular and acceptable attendance in accordance with Time Away From Work policy
• Ability to work evening, weekend and holiday shifts to support the UM Department
• Other duties as requested

Qualifications:

• High School Diploma and preferred 1-2 years' experience in a managed care environment
• Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
• Effective oral and written communication skills
• Strong customer orientation
• Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
• Excellent typing skills

Knowledge, Skills, Abilities Required:

• Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
• Proficient knowledge of departmental policies and procedures
• Knowledge of Medicare Regulatory Requirements

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 hourly rate of USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: for support. Do not email 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.