Claims Denials Supervisor- MDLIVE (Finance)
POSITION SUMMARY
Expanding access to affordable, high quality health care starts at MDLIVE. At MDLIVE, innovative ideas in healthcare are created every day. The Denials Supervisor is responsible for monitoring all denials related aging revenue by reviewing, trending, and tracking all claims rejected and/or denied by system edits and or payer. This role will support 10+ direct reports with ongoing training, mentoring, and install proper KPIs.
ESSENTIAL FUNCTIONS
- Engages cross-functionally to problem solve client claim issues
- Assists in implementing physicians' queries when appropriate and interacts with credentialing staff as per account requirements
- Follows the Official ICD-10-CM, CPT, and HCPCS Guidelines, AMA CPT Guidelines, and CMS directives, as related to claim denials and appeals
- Pursues collection activities to obtain reimbursement from payers and/or patients
- Frequent follow up with payers and/or patients on outstanding accounts
- Sets daily standard work for denials team
- Assigns claims to team via Athena worklist
- Runs metric reports and coach team to reach their goals
- Develops and implements coding RCM procedures by analyzing current procedures, recommending changes, and creating SOP's
- Answers internal/external client questions by researching and interpreting data
- JIRA ticket management - maintain denials related Jira tickets within 30 days
- Monitors and sets action plan to reduce denials and rejections
- Works cross functionally to solve outstanding claim issues
- Must be able to read and understand a payer/client contract
- Works payer projects, with short timelines
- Demonstrated ability to problem solve and utilize analysis experience and judgement to make accurate decisions
- Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
QUALIFICATIONS
- Associate's/Bachelor's degree preferred or equivalent relevant work experience
- 5+ years of Telehealth, Urgent Care, Primary Care, Wellness Care, Behavioral Health Care, Dermatology denials experience preferred
- 5+ years of supervisor or manager experience preferred
- 2+ years minimum of front and back-end office experience
- Working knowledge of payer implementations
- Proficiency in working with Athena, Excel, pivot tables, Outlook email, Salesforce
- Working Knowledge of Health Insurance EOB's, denials and appeals
- Ability to meet assigned deadlines
- Strong understanding of claims cycle
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 53,300 - 88,900 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 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: 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.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
