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Audit Specialist II
The Cigna Group. Facilitate processing of audits within the parameters of the audit program .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in home infusion revenue cycle management, including proficiency in Federal and State billing guidelines, claim audits, and quality assurance processes. Strong communication and problem-solving skills are essential for resolving discrepancies and training staff on best practices.
Highest-signal resume keywords
Home Infusion Revenue Cycle ManagementFederal And State Billing GuidelinesClaim AuditsCPR+ SoftwareICD-10, CPT-4, HCPCS Billing
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim AuditsQuality Audit ChecksMedical TerminologyBilling GuidelinesProblem-SolvingAttention To DetailTask PrioritizationStandard Operating Procedures DevelopmentClaim Denial AuditsPayer Audits
Soft Skills
Verbal CommunicationWritten CommunicationCustomer Service OrientationInterpersonal SkillsOrganizational Skills
Tools & Technologies
Microsoft Office SuiteCPR+ Software
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
MedicareMedical AssistanceHighmarkUPMC Health PlanQuality Focus Audits
About the role
Key responsibilities & impact- Facilitate processing of audits within the parameters of the audit program
- Review claim submissions for accuracy
- Identify root causes of claim issues
- Resolve discrepancies and share findings with leadership
- Prioritize and complete assigned tasks
- Complete payer audits before deadlines
- Maintain current knowledge of state and federal guidelines and payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan
- Perform quarterly quality audit checks
- Audit new employees until the accuracy threshold is met
- Perform claim denial audits
- Conduct ongoing quality focus audits on billing and collection activity
- Assist with training on recurring errors found during quality audits
- Assist in developing Standard Operating Procedures
- Complete special projects as requested
- Perform in accordance with system-wide competencies and behaviors
Requirements
What you’ll need- High School diploma or GED required
- Proficiency in the Microsoft Office Suite
- 3+ years of experience in home infusion revenue cycle
- Strong knowledge of Federal and State billing guidelines
- Working knowledge of basic medical terminology required
- Excellent verbal and written communication skills
- Strong customer service orientation
- Excellent problem-solving skills
- Strong interpersonal and organizational skills, with the ability to work on multiple tasks simultaneously with attention to detail
- Experience with CPR+ Software
- Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred
- Home internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload if working from home
- Candidates in applicable states who use tobacco/nicotine must enter a qualifying smoking cessation program before employment
Benefits
Comp & perks- Annual bonus plan eligibility
- Medical, vision, and dental benefits
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Tobacco-free policy