Clinical Program Advisor - Work from Home Anywhere, USA (AAPC or AHIMA Coding Certification Required) LPN or RN Preferred

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions.  If you think the open position, you see is right for you, we encourage you to apply! Our people make all the difference in our success.

This is a work from home opportunity from anywhere within the US.

Role Description:

The 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 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 business 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:

• A Program Advisor 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 to identify and validate reimbursement policy opportunities
• Document coding logic and data requirements for matrix partners
• Author and maintain reimbursement policy language, coding, and templates
• Presenting reimbursement policy summary for applicable governance
• Be a subject matter expert (SME) on existing and new reimbursement policy topics
• Clearly communicate, be collaborative, while working effectively and efficiently with other areas

Qualifications:

• 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) experience required
• Active unrestricted LPN or RN license in state of residency
• Three years LPN or RN experience
• 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
• Nursing degree preferred
• 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
• Strong communication skills to include written, oral and group presentation
• Effective analytical and problem-solving skills
• Passionate 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.

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 benefit