Audit Specialist II

The Audit Specialist II is responsible for facilitating the processing of audits within the parameters of the audit program.

You will review claim submissions for accuracy, identify root causes of claim issues, and resolve discrepancies. Your goal will be to share findings with leadership and contribute to the improvement of processes.

Key Responsibilities:

• Prioritize and complete assigned tasks effectively
• Conduct payer audits in a timely manner, meeting deadlines
• Maintain up-to-date knowledge of state and federal guidelines, as well as payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan
• Perform quarterly quality audit checks
• Complete quality audits for new employees until accuracy thresholds are met
• Conduct claim denial audits and ongoing quality focus audits on billing and collection activities
• Assist with training on recurring errors found during quality audits
• Contribute to the development of Standard Operating Procedures
• Complete special projects as requested
• Adhere to system-wide competencies and behaviors

Requirements for Success:

• High school diploma or GED required
• Proficiency in Microsoft Office Suite
• At least 3 years of experience in home infusion revenue cycle
• Strong knowledge of federal and state billing guidelines
• Basic understanding of medical terminology
• Excellent verbal and written communication skills
• Strong customer service orientation
• Effective problem-solving skills
• Interpersonal and organizational skills, with the ability to multitask and maintain attention to detail
• Experience with CPR+ Software
• Familiarity with ICD-10, CPT-4, HCPCS, and Medicare billing (preferred)

The anticipated hourly rate for this position is $27 - $40, depending on experience and geographic location. This role is expected to be eligible for an annual bonus plan.

The Cigna Group offers a comprehensive range of benefits, including:

• Medical, vision, and dental coverage
• Well-being and behavioral health programs
• 401(k) plan
• Company-paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays and leaves of absence