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Durable Medical Equipment (DME) Case Administrator - eviCore - Remote at Cigna

Posted in General Business 12 days ago.

Type: Full-Time
Location: Bloomfield, Connecticut

Job Description:

Delivers straightforward administrative and/or other basic business services in Customer Service. Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, providers and/or others for information and assistance. Performs research to respond to inquiries and interprets policy provisions to determine most effective response. Mails or routes claim forms and supporting documentation to various units for final processing. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. Issues tend to be routine in nature. Good knowledge and understanding of Customer Service and business/operating processes and procedures. Works to clearly defined procedures under close supervision.

What you must have

  • High School graduate with diploma or GED.

  • Associates or Bachelor's degree, preferred.

  • 2+ years of experience in healthcare contact center or customer service preferred.

  • Medical background with Post-Acute Care experience preferred.

  • Experience with insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid preferred.

  • Various schedules to cover operating hours (7AM - 8PM CST).

  • Maintain flexibility to variations in work volume/work schedule, which sometimes require extended working hours.

  • Position may require rotating weekend and holiday coverage. Certain postings may require regular weekend coverage based on business and client needs.

  • Currently position is remote but position location is subject to change.

  • Provides excellent customer service to clients and providers by ensuring there is full understanding of the resolution or action plan.

  • Ability to navigate multiple platforms that contain provider data, member information, and authorizations.

  • Daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.

  • Time-management: Ability to effectively manage one's time and resources to ensure that work is completed efficiently. Excellent organizational skills.

  • Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership.

  • Critical-Thinking/Decision-making: Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities.

  • Autonomy: Ability to work independently with little to no supervision.

  • Ability to complete special projects or other duties as assigned.

  • Proficient with various applications or software, such as: Microsoft Outlook, Word, Excel, and PowerPoint and demonstrate ability to utilize all resources to support the manual functionality of the PAC system.

Duties and Responsibilities

  • Maintain workflow activities for the PAC Health plan product for inbound and outbound communications between eviCore Healthcare stakeholders and external hospitals, physicians and Post-Acute Care providers.

  • Demonstrate complete understanding of how to research and resolve issues pertaining to the pre-certification process and day-to-day operational concerns using defined processes.

  • Demonstrate full understanding and ability to differentiate the Post-Acute Care processes over multiple health plans across multiple states to ensure compliance with both Medicare and Medicaid guidelines by state regulations.

  • Communicate all state specific and national health care laws to external hospitals, physicians and Post-Acute Care providers including the appeals/reconsideration policies.

  • Inbound and outbound communications tasks include coordination of inbound requests from hospitals, physicians and Post-Acute Care providers for pre and re-certification, status checks on existing cases, directing calls to internal departments, notification calls to hospitals and Post-Acute Care providers regarding incomplete pre-certification requests, as well as authorization approvals.

  • Receive faxed information via internal and external systems from hospitals, physicians and Post-Acute Care providers, completing the activity for the request including case creation for pre-certification, attaching to an existing case for re-certification, and assigning to the appropriate staff for case closure.

  • Evaluate client trends to report and partner with the appropriate internal stakeholders in order to address and resolve through facilitation of communication between clients, providers, IT and other eviCore healthcare team members.

  • Position is part of a call center and will require working phone for the majority of the shift.

  • Required to complete pre-employment skill test for typing and computer literacy.

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 17 - 23 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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.

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