The Cigna Group is hiring a Medical Coder to join our Evernorth division. In this role, you will conduct outpatient post-service administrative claims or appeals coverage determinations, such as bundling reviews. You will apply benefit plan limitations, exclusions, and federal/state regulatory requirements to each case review while maintaining strict HIPAA compliance.
What You'll Do
- Make coverage determinations on retrospective administrative outpatient claims and appeals, such as bundling reviews, using standard policies and procedures.
- Research claims, appeals information, review request letters, and related materials to make accurate coverage determinations.
- Accurately screen claim referrals or appeals subject to state or federal mandates.
- Confirm appeal set up meets state regulatory requirements on non-ASO appeals.
- Communicate approval or denial determinations as required.
- Document all retrospective administrative outpatient claims and appeals in the appropriate systems.
- Manage your assigned workload to completion within required timeliness metrics.
- Complete all required training per regulatory and credentialing body standards.
- Limit requests for protected health information (PHI) to the minimum necessary amount needed to perform job functions.
What We're Looking For
- High school diploma or GED.
- Coder certification: AAPC CPC or AHIMA CCS-P (Apprentice stage not eligible).
- 1+ year of experience with CPT-4 and ICD-9/ICD-10 coding.
- Strong knowledge of medical terminology, anatomy, and physiology.
- Solid research and analytic skills.
- Proven ability to work independently with good judgment.
- Demonstrated detail orientation and strong organizational skills.
Nice to Have
- Familiarity with state and federal regulations.
- 2+ years of experience in billing, claims, customer service, or health insurance.
Benefits & Compensation
- Hourly compensation: $19 - $29 USD.
- Comprehensive health benefits including medical, vision, dental, and well-being and behavioral health programs.
- 401(k) with company match.
- Company paid life insurance.
- Tuition reimbursement.
- Minimum of 18 days of paid time off per year plus paid holidays.
Work Mode
This is a fully remote position.
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.
