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Claims Processor Service Analyst for Cigna LifeSOURCE

Company: Cigna TTK Health Insurance Company Limited
Location: Scranton
Posted on: December 8, 2018

Job Description:

Claims Processor Service Analyst for Cigna LifeSOURCE Examines and reprices paper and electronic claims for Network Access Client (NAC) business for the CIGNA LifeSOURCE Transplant Network. Determines steps necessary for repricing. Ability to understand and apply LifeSOURCE contract terms and rates, as well as individual Letters of Agreements, to claims and reprice accurately. Be able to enter information into an Access database. Typically has at least 5 years experience in claims processing. Responsible for independently reviewing complex, specialty claims. Works closely with LifeSOURCE Transplant Care Coordinators (nurses). Responsibilities: Reprice claims for growing NAC business for Cigna LifeSOURCE network meeting turnaround times of 5 business days and 98% accuracy Be able to understand and apply the various provisions and rates from 160+ LifeSOURCE contracts Determine if claims are transplant or non-transplant related, appropriate zone and apply correct rates from LifeSOURCE contract Research and review claims issues, working with providers, payers, contracting team and NAC nurse coordinators to resolve Participate on conference calls as needed for any escalated issues Have experience in Excel and Access or the ability to learn how to enter data into these applications Work closely with LifeSOURCE nurse coordinators to determine zones as well as transplant related and non-transplant related claims Respond to telephonic and e-mail claims inquiries from clients and providers At least 5 years experience in medical claims processing and adjudication with experience in inpatient, outpatient hospital and professional claims required Transplant claims experience a plus Strong verbal and written communication skills Strong analytical and problem solving skills Highly motivated, self-starter with ability to work independently and as a team to achieve goals and objectives Ability to work with providers, contracting, account managers, nurse coordinators and clients to resolve claims issues Ability to understand transplant provider contracts, interpret contract language and rate provisions Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: ********************* United States-Pennsylvania-Scranton United States PA 53 Glenmaura Natl Blvd (USAPAJB000) 53 Glenmaura National Blvd Scranton, 18507 PA 53 Glenmaura Natl Blvd 53 Glenmaura National Blvd Scranton Bus Ops--Claims Yes Full-time Day Job Regular Standard Individual Contributor Dec 4, 2018, 2:19:12 PM

Keywords: Cigna TTK Health Insurance Company Limited, Scranton , Claims Processor Service Analyst for Cigna LifeSOURCE, Professions , Scranton, Pennsylvania

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