Clinical Program Advisor, CPC Certification Required ( LPN/RN Preferred) Work from Home, Anywhere, USA

Clinical program Advisor Role Description:

The Clinical Program Advisor is part of an innovative team who have overall accountability for reimbursement policy creation, maintenance, and project support. This individual will partner with many areas including Prepay, Business Operations, and other matrix partners to assist with the implementation of reimbursement policies.

As a Clinical Program Advisor, the incumbent should demonstrate critical thinking, an ability to work well in a fast paced, team-based environment, both independently and partnering with other business areas to make solid, well-informed decisions based on data and multiple inputs to achieve CPU objectives.

Provides expert content/professional leadership in relation to coding and reimbursement intent. Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives. Uses deep professional knowledge and acumen to advise others. Recognized internally as a subject matter expert

Knowledge and experience with claims data and Cigna's claims systems are a plus. Advantages of this position include a positive team atmosphere, cooperative business partners and work/life balance.

Responsibilities:

• An Advisor also known as an “author,” is responsible for the identification of reimbursement policy opportunities, policy maintenance, and project work
• Researching competitive landscape for current industry trends, and creation of code edit strategies to align with reimbursement policies
• Evaluating the impact of industry changes, code additions, revisions, and/or deletions to associated reimbursement policy and code edits
• Review data analytics and inquiries to validate reimbursement policy performance as well as potential new savings opportunities
• Document coding logic and data requirements for policy implementation for matrix partners
• Author and maintain reimbursement policy language, coding, and templates/blueprints
• Present reimbursement policy data and documentation for applicable governance
• Be a subject matter expert (SME) on assigned reimbursement policy topics
• Analyzes of potential policy from clinical operational perspective
• Collaborates with project stakeholders
• Responds to inquiries of policy and coding inquiries within 5 days
• Participates in process improvement, maintenance, and implementation of Standard Operating Procedures (SOPs)
• Clearly communicates, is collaborative, while working effectively and efficiently with other areas

Qualifications:

• Nursing degree
• Active AAPC or AHIMA coding certification required e.g., CPC, CCS-P, CIC, or COC, with a minimum of 3 years procedure coding (HCPCS/CPT) recent experience required
• Healthcare insurance claim editing/analysis background required
• Strong attention to detail to include ability to analyze claim data analytics
• Proficient at documenting necessary coding/billing requirements for code editing
• Excellent business writing skills
• Facility coding certification or billing experience a plus
• Medicare coding and/or reimbursement experience preferred
• Must be proactive, and team oriented with an ability to foster collaboration
• Value others’ perspectives for successful implementation of organizational projects
• Proven ability to prioritize multiple tasks in a fast-paced environment
• Effective communication skills to include written, oral and group presentation
• Effective analytical and critical thinking skills
• Enthusiastic regarding quality of product
• Proficiency in Microsoft Office applications

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 92,700 - 154,500 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