POSITION SUMMARY

Provides assistance with training to new staff.  Provide administrative support in response to pharmacy remittance requests received from pharmacies, Call Center, Account Managers and management personnel. Subject Matter Expert (SME) on the Pharmacy Remittance daily operations. Provide direction and guidance in absence of supervisor. Identify, analyze and resolve issues across multiple provider platforms. Research and resolve most complex exceptions due to over/underpayments. Collaborate with others on resolving issues cross functionally.  SME on electronic 835s and electronic payments. Create updates and maintain training guide. Audit the work of others as QA to ensure accuracy of work. Maintain tracking logs. Project Management in the distribution and oversight of work delegated to others. Identify providers with negative balances and manage the collection and accounting related to the payments.   Needs minimal direction from supervisor in carrying out the above. Carries out all assignments in accordance with Policies and Procedures.

ESSENTIAL FUNCTIONS

• Be point of contact for escalated issues for new employees with system applications and processes. Provide direction and support of proper communication to external and internal departments.

• Provide QA support on electronic 835 and banking information and data entry setup to ensure adherence on multiple remittance platforms to comply with contract terms per Federal and State requirements, while optimizing ESI working capital.  Ensure recordkeeping is up to date and stored appropriately.

• Delegate work and monitor progress/results with the Pharmacy Remittance team. Project activity includes research and communication between cross-functional teams; collaboration with Treasury, Accounting, Retail Network and Account Management.  Communicate with providers.  Work with Client Connectivity/B2B and Information Exchange to assist with the implementation and error resolution of electronic media of multiple remittance platforms.  Identify issues with remittance media and request recreation of data for remittance processing. Resolve issues for corporate chains and independent pharmacies regarding paper, or electronic remittance advices. Establish good working relationship with electronic third party vendors, PSAOs and Chains.

• Identify providers with negative balances and manage the collection and accounting related to the payments.  Activity includes research and communication with providers, collaboration with Accounts Receivable, Accounting and make recommendations when accounts are uncollectible.

• Analyze and review need for manual checks and submit for further approval.  Maintain check trace/request data in central log.  Monitor Data Serv to ensure checks have been issued.  Submit void/stop requests through ICW.

• Provide backup for QA process for EFT and 835 setups as needed.  Provide backup for daily check pull and mailing process.

• Manage check distribution to ensure accuracy and timeliness, meeting provider contract terms, Federal and State requirements and ESI protocol for optimizing working capital.  This activity includes ongoing and open communication with Network Contracting, Legal, Treasury, Accounting and Fraud, Waste & Abuse.

• Special projects as requested by Management.

QUALIFICATIONS

• 3-5 years relevant experience in related field of Finance, Healthcare, PBM or Associates degree with 1-2 years relevant experience.

• Proficient in Microsoft Excel (VLOOKUP and Pivot Tables) 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.

• Maintain 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 work independently or as a team; ability and desire to mentor others.

• Desire and ability to exceed customer expectations; provide exceptional customer service to internal and external customers.

This role is Flex which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.