Clinical Program Advisor - Work from Home Anywhere, USA (AAPC or AHIMA Coding Certification Required) LPN or RN Preferred ID-5267

December 30, 2024

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

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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