Financial Operations Representative - Missouri Work at Home
## Essential Functions
- Provide administrative support in response to pharmacy remittance requests received from pharmacies, call center, account managers and management.
- Provide first tier escalation on research and resolutions to exceptions due to overpayments or unpaid claims.
- Manage moderately complex remittance issues with VA providers, state agencies and Medicaid subrogation providers, plus pharmacy chains and independents.
- Correspond via mail, email, fax or phone daily with providers and vendors regarding remittance and claim status research.
- Collaborate with IT, Manual Claims, Account Management, Pharma and Retail Relations on investigating and resolving underpayment/over-payment issues minimizing impact to pharmacies and clients.
- Work cross functionally in the resolution and communication of remittance issues such as claims research, adjustments or pharmacy set ups.
- Identify and research chain affiliation errors.
- Data entry and QA of adjustments and EFT banking setup to ensure adherence on multiple remittance platforms to contract terms per Federal and State requirements, while optimizing ESI working capital.
- Work with the Secure File Transfer Services (SFTS)/B2B teams to assist with the implementation and error resolution of electronic media of multiple remittance platforms.
- Identify issues with electronic 835 files and request recreation of data for remittance processing.
- Synchronize the setup of electronic ASCx12N 835 files with the provider, IT and B2B teams.
- Resolve issues for corporate chains and independent pharmacies regarding paper, or electronic remittance requests.
- Establish good working relationships with assigned electronic third-party vendors, chains, PSAO contacts.
- Mentor/assist new employees with all aspects and QA work for accuracy.
- Compile monthly data of completed tasks for management review to ensure department’s goals are met.
- Special projects as requested by management.
## Qualifications
- Must be able to work Monday-Friday with a flexible start time between 7am-8am CST
- High school diploma or GED required
- 2+ years relevant experience preferred
- Proficient in Excel and Microsoft Word
- Ability to communicate professionally with all levels of company personnel and outside vendors
- Strong organizational skills with the ability to meet multiple deadlines
- Accurate and detail oriented in all aspects of performance
- Uphold high levels of integrity in all aspects of performance
- Ability to maintain confidentiality in all aspects of the work including PHI, PII and financials
- Desire and ability to coach and mentor others
- Desire and ability to exceed customer expectations
- Provide exceptional customer service to internal and external customers
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.About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, 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.
If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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- Provide administrative support in response to pharmacy remittance requests received from pharmacies, call center, account managers and management.
- Provide first tier escalation on research and resolutions to exceptions due to overpayments or unpaid claims.
- Manage moderately complex remittance issues with VA providers, state agencies and Medicaid subrogation providers, plus pharmacy chains and independents.
- Correspond via mail, email, fax or phone daily with providers and vendors regarding remittance and claim status research.
- Collaborate with IT, Manual Claims, Account Management, Pharma and Retail Relations on investigating and resolving underpayment/over-payment issues minimizing impact to pharmacies and clients.
- Work cross functionally in the resolution and communication of remittance issues such as claims research, adjustments or pharmacy set ups.
- Identify and research chain affiliation errors.
- Data entry and QA of adjustments and EFT banking setup to ensure adherence on multiple remittance platforms to contract terms per Federal and State requirements, while optimizing ESI working capital.
- Work with the Secure File Transfer Services (SFTS)/B2B teams to assist with the implementation and error resolution of electronic media of multiple remittance platforms.
- Identify issues with electronic 835 files and request recreation of data for remittance processing.
- Synchronize the setup of electronic ASCx12N 835 files with the provider, IT and B2B teams.
- Resolve issues for corporate chains and independent pharmacies regarding paper, or electronic remittance requests.
- Establish good working relationships with assigned electronic third-party vendors, chains, PSAO contacts.
- Mentor/assist new employees with all aspects and QA work for accuracy.
- Compile monthly data of completed tasks for management review to ensure department’s goals are met.
- Special projects as requested by management.
## Qualifications
- Must be able to work Monday-Friday with a flexible start time between 7am-8am CST
- High school diploma or GED required
- 2+ years relevant experience preferred
- Proficient in Excel and Microsoft Word
- Ability to communicate professionally with all levels of company personnel and outside vendors
- Strong organizational skills with the ability to meet multiple deadlines
- Accurate and detail oriented in all aspects of performance
- Uphold high levels of integrity in all aspects of performance
- Ability to maintain confidentiality in all aspects of the work including PHI, PII and financials
- Desire and ability to coach and mentor others
- Desire and ability to exceed customer expectations
- Provide exceptional customer service to internal and external customers
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.About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, 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.
If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Apply tot his job
Apply To this Job