Medicare Appeals Processing Representative Full Time

Company: Cigna Healthcare
Location: Remote
Position Type: Full-time
Hourly Pay: $17 – $25 per hour
Shift: Monday to Friday, Preferred Hours 8:00 AM – 4:30/5:00 PM CST

Are you looking for a job that allows you to work from home? Do you have experience in healthcare or Medicare claims? If so, this job might be perfect for you! Cigna Healthcare is looking for a Medicare Appeals Processing Representative to help process Medicare appeals and ensure everything is correct. If you want to be part of a team that helps people with their healthcare needs, read on to find out more!

Job Description

As a Medicare Appeals Processing Representative, your job is to make sure that all Medicare appeals are handled the right way. You will look at the documents and information provided, figure out the correct way to process the appeal, and enter it into the system. You will also work with different people, including members, doctors, and other team members, to make sure everything is resolved and processed on time. This is a full-time job where you will work 40 hours a week from Monday to Friday. You will need to be available to work between 8:00 AM and 4:30/5:00 PM Central Standard Time.

Job Details

Key Responsibilities:

As a Medicare Appeals Processing Representative, your main tasks will include:

• Investigating appeal requests: You will carefully check the documents to figure out what kind of appeal it is (like a grievance or a coverage determination). You will make sure it is processed the right way.
• Managing casework: You will get cases from a queue, look at them, and make sure they are handled according to the rules. You will check the appeal documents to make sure everything is correct.
• Ensuring things are done on time: You will make sure that all the information is entered into the system and that everything is processed correctly and quickly, following all deadlines.
• Communicating with others: You will talk to people like doctors, team members, and members to get the information you need and make sure the appeals are handled on time.
• Meeting performance goals: You will be expected to meet goals for how fast and accurate you are at processing appeals, how satisfied members are, and your attendance.
• Identifying improvements: You will help find any ways to improve the process by looking at reports and suggesting changes.

Job Requirements:

To be successful in this role, you should meet these qualifications:

• Education: You need to have a high school diploma or GED. It’s also helpful if you have experience as a medical assistant or in Medicare claims.
• Experience: It’s preferred that you have at least 1 year of experience working with Medicare Advantage Health Plans or in a similar healthcare setting.
• Skills:
  • You should be good at using Microsoft Office (like Word, Excel, PowerPoint, and Access).
  • You need to be able to write and talk clearly.
  • You should be able to handle many tasks at once and meet deadlines.
  • You need to be detail-oriented and able to think critically to solve problems.
• Systems Knowledge: If you are familiar with systems like MHK, Facets, OneView, or QNXT, that’s great, but it’s not required.
• Work Environment: This job is remote, meaning you will work from home. You will need a reliable internet connection with speeds of at least 10Mbps download/5Mbps upload to do your job well.

Benefits

At Cigna Healthcare, we want to make sure you are healthy and happy. That’s why we offer great benefits, including:

• Health Insurance: We provide medical, dental, and vision insurance to keep you and your family covered.
• Paid Time Off (PTO): You will get at least 18 days of paid time off every year, plus paid holidays.
• Retirement Savings: We offer a 401(k) plan with company matching to help you save for the future.
• Life Insurance: We provide life insurance to give you peace of mind.
• Additional Benefits: We also offer programs like tuition reimbursement, smoking cessation programs, and wellness programs.

Why Work at Cigna Healthcare?

Cigna Healthcare is part of The Cigna Group, a company that helps people understand their healthcare and make better choices for their health. We want to help our employees grow and make a difference in people’s lives. As a Medicare Appeals Processing Representative, you will help make sure Medicare members get the healthcare they need. Plus, since this is a remote job, you will have the flexibility to work from home.

How to Apply

If this job sounds like a good fit for you, here’s how you can apply:

1. Create an Indeed account: You need an Indeed account to apply for this position.
2. Submit your application: Go to Cigna Healthcare’s job listing on Indeed and apply by sending in your resume.
3. Prepare for an interview: If your application is selected, you will be contacted to set up an interview.

Important Notes:

• This job is eligible for an annual bonus.
• Cigna has a tobacco-free hiring policy in certain states. If you use tobacco or nicotine, you may need to complete a smoking cessation program before starting the job.
• Cigna Healthcare is an Equal Opportunity Employer. This means we consider all applicants fairly, regardless of their race, gender, age, or other factors.

Join the team at Cigna Healthcare and help make a difference in the healthcare world. We look forward to hearing from you!

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