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Intake Care Senior Representative at Cigna

Posted in General Business 30+ days ago.

Type: Full-Time
Location: Nashville, Tennessee





Job Description:

The Intake Care Senior Representative is responsible for accepting pre-certification requests from physicians and members and processing in accordance with CMS guidelines. The Intake Care Senior Representative will communicate with internal and external providers regarding authorization status.

Essential Duties and Responsibilities:


  • Receive request for authorization from providers and members; 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.

  • Enter authorization requests and route to Part B Clinical Reviewer for decision.

  • Maintain benchmark standards for TAT (Turn around Time) as established by the organization.

  • Provide outcomes on authorization requests to members and/or providers based on benchmark standards for authorization decisions.

  • Processes denials including correspondence sent to families, members, facilities and applicable contracted providers.

  • Entering authorizations into the claims system and testing claims for proper co-pay costs.

  • Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow.

  • 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 at such level as is determined at the employer's sole discretion.

  • Process requests via faxes, phone, and provider portal

Qualifications:


  • High School Diploma and 3-4 years' experience in a managed care environment.

  • Must be proficient in medical terminology, CPT and ICD-9/ICD-10 coding.

  • Knowledge of Medicare and HIPPA.

  • Appropriate Pharmacy Technician certifications/licensing as required by the state of residence or the ability to obtain within 1 year of position start date.

  • Certified Bilingual English/Spanish preferred.

  • Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.

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 member

  • Able to work in a dynamic, fast-paced team environment and to promote team concepts.

  • Availability to work weekends and holidays including evening hours.

Computer Skills:

Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.





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