What are the responsibilities and job description for the Nurse Coder Fraud Investigator - Special Investigations Unit (SIU), Work from home position at Cigna?
Join our Special Investigations Unit as a Nurse Coder Fraud Investigator, supporting our commercial and government investigations. In this role, You will conduct and document the review of medical records to determine if the documentation supports the services submitted to Cigna. You will evaluate the medical record documentation for completeness and accuracy, and identify deviations from healthcare industry coding guidelines, as well as clinical and reimbursement policies. In addition, this position works closely with Medical Directors, the investigative teams, and legal. In addition, the role requires the individual to help mitigate FWA globally by providing feedback to the analytics team related to trends and schemes.
Responsibilities
- Analyze and interpret patient medical records pertaining to FWA investigations
- Compare to information submitted on the claims in order to determine amount and nature of billable services
- Determines appropriateness of billing and reimbursement
- Documents findings for each claim line
- Summarize findings in a written report
- Abstracts CPT, HCPCS, ICD-9/ICD-10, Revenue Codes, and DRG from medical records.
- Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations
- Interface with other clinicians including internal Medical Directors
- Provide training to SIU staff related to clinical topics as needed
- Ability to explain coding guidelines to non-coders in a clear and concise manner
- Assist with settlement discussions
Qualifications / Requirements
- Must have valid state Registered Nurse License
- Certified Professional Coder
- Health Insurance Industry Experience – Special Investigations Unit preferred
- Computer and organizational skills
- Strong communication skills, both written and oral, are essential
- Must be able to adapt to changing and competing priorities
- Moderate to advanced knowledge with Word, Excel, PowerPoint, and Outlook
This role is WAH, which allows most work to be performed at home. WAH employees must be fully vaccinated against COVID-19 if they choose to come onsite or if required to periodically come on site.
For this position, we anticipate offering an annual salary of $77,100 - $128,500, depending on relevant factors, including experience and geographic location.This role is also anticipated to be eligible to participate in an annual bonus plan.
Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class 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 dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our careersite: www.cigna.com/careers
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.
