Job Title: Medicare Appeals Case Management Analyst - Remote Opportunity

Join our team as a Medicare Appeals Case Management Analyst and play a vital role in driving success in our organization! We are seeking a highly skilled and motivated individual to fill this remote position, which offers a competitive salary and an immediate start for the right candidate. As a Case Management Analyst, you will be responsible for communicating critical information to members, providers, and internal stakeholders regarding Medicare appeals and related issues.

In this role, you will analyze and respond to appeals from members, member representatives, and providers, researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal. You will also provide oversight and assistance to Medical Management staff, review documentation to ensure accuracy, and prepare case files for submission to Independent Review Entities. This is a full-time position (40 hours/week) with core business hours generally between 8:00 am - 5:00 pm CST, Monday through Friday, with occasional weekend and holiday coverage.

Key Responsibilities:

• Analyze and respond to Medicare appeals from members, providers, and internal stakeholders
• Research and apply Medicare and Medicaid regulations to determine appeal outcomes
• Provide oversight and assistance to Medical Management staff
• Review documentation to ensure accuracy and completeness
• Prepare case files for submission to Independent Review Entities
• Communicate appeal information to members, providers, and internal stakeholders within required timeframes
• Meet performance goals in efficiency, accuracy, quality, member satisfaction, and attendance
• Adhere to department workflows, desktop procedures, and policies

Requirements:

• Unencumbered LPN/LVN licensure in the state of residence
• 3-5 years of experience in Medicare Advantage Health Plans or related experience in a healthcare setting
• Working knowledge of Medicare Advantage, Original Medicare, and Medicaid appeal regulations
• Excellent written and oral communication skills
• Ability to work objectively and provide fact-based answers with clear and concise documentation
• Proficient in Microsoft Office products (Access, Excel, PowerPoint, Word)
• Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases

About Cigna Healthcare: Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Equal Employment Opportunity: Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, 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.

Ready to Apply?

If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now! We are excited to review your application.