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CIGNA-Franklin, TN, 37068
Conducts quality reviews of Practitioner and/or Facility/Ancillary contracts. Conducts comparison of contract data relative to provider data and/or demographic and reimbursement data submitted for processing. Assesses the accuracy of provider data processed in accordance with documented and standard operating policies and procedures. Assists in the analysis and trending of audit findings. Interacts with Audit staff, Network Operations, Health plans, Contracting, and other Quality Assessment and Control partners. Requires 0-3 years of experience with Practitioner and/or Facility/Ancillary pr...
Auditor Jobs in Franklin, Tennessee Jobs
UnitedHealth Group | Franklin, TN, 37067 | 5
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health. Ingenix is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decis...
CIGNA | Franklin, TN, 37068 | 2-4
Conducts quality reviews of Practitioner and/or Facility/Ancillary contracts. Conducts comparison of contract data relative to provider data and/or demographic and reimbursement data submitted for processing. Assesses the accuracy of provider data processed in accordance with documented and standard operating policies and procedures. Assists in the analysis and trending of audit findings. Interacts with Audit staff, Network Operations, Health plans, Contracting, and other Quality Assessment and Control partners. Requires 0-3 years of experience with Practitioner and/or Facility/Ancillary pr...
CIGNA Jobs
CIGNA | Saint Louis, MO, 63128 | >8
Manages the accurate and timely adjudication of claims and administers disposition according to contractual benefits and company procedures. Provides direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. Responsible for monitoring claim service standards. Typically has B.A. degree and eight or more years of experience in benefits and claims administration with three or more years of management experience. May serve as a single point of contact for customer base to manage account, trend issues and develop action plans for improvement. Re...
CIGNA | Hartford, CT, 06102 | 3
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. Conducts negotiations and drafts individual contracts. Ensures the smooth operation and administration of provider agreements. Track financial performance of contracts and ensure compliance with contracting guidelines. May provide guidance or expertise to less experienced specialists. Typically requires a Bachelor's degree in a related area. Three years of related experience, or strong financial, medical, economics or network management skills. Strong written and ...
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