Denials Analyst

Responsibilities: Generate appeals based on the dispute reason and contract terms, specific to the payer (including online reconsiderations) Research and resolve all outstanding denials and complete all necessary follow up within a timely and accurate manner. Follow specific payer guidelines for appeals submission and escalate exhausted appeal efforts for resolution. Create a systematic reporting mechanism monthly that analyzes denials. Identify changes and/or trends, and reports these to management. Validate denial reasons and ensure the reason is accurate and it reflects the denial reasons codes. Develop, produce and publish report metrics and KPI's (Key Performance Indicators) which support revenue integrity. Partner with the Accounts Management team regarding client issues Research contract terms/interpretation and compile necessary supporting documentation for appeals adjudication issues, and referral to refund unit on overpayments. Perform research and determine corrective actions to map denial codes and route account appropriately. Identify all denial trends and provide education of steps to prevent future avoidable denials. Communicate all denial trends and increases to direct manager. Organize the workflow to ensure that denials are processed according to departmental policy and standards. Cross reference the TeleHealth insurance plans to the insurance plans listed in our billing system when applicable. Complete special projects as assigned by Manager. Prepare/attend meetings as requested Experience: Bachelor's Degree in Finance, Healthcare or related field preferred. Two to five years related experience in medical claims recovery/ collections, rules and regulations or combination of experience. Must be proficient in Microsoft Excel and PowerPoint License/Registration/Certifications include CPC and/or CPC-H certification preferred. 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 annual salary of 56,300 - 93,800 USD / yearly, 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. About Cigna Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make? 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. Cigna 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. Doing something meaningful starts with a simple decision, a commitment to changing lives. Our mission is to improve the health, well-being, and peace of mind of those we serve. We're making real progress, but we still have work to do. That's where you come in. From disruptive innovation in health services, medical advancements, and sustainable solutions – we're transforming health care as we know it. We're passionate and we care about what we do – being there when our customers, colleagues, partners, and communities need us most. If you like taking on bold challenges, driving growth, and improving lives, this is the place for you.