This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves managing the full Medicaid recertification process for residents within supported healthcare facilities. - Manage the full Medicaid recertification process, including tracking timelines and submission deadlines - Review resident files to ensure all documentation meets Medicaid compliance standards - Coordinate with facility staff to obtain required documentation and outstanding information - Prepare and submit recertification documentation accurately and timeously - Communicate with state Medicaid agencies and facility billing departments where required - Maintain accurate and up-to-date records within internal systems - Identify documentation gaps and proactively resolve compliance issues - Ensure recertifications are completed before eligibility expiration to prevent funding disruptions - Provide additional administrative and operational support to facilities as needed Qualifications - Minimum 2+ years’ experience working with medical aid processes within a healthcare, hospital, or long-term care environment - Familiarity with U.S. Medicaid and Medicare processes, eligibility requirements, and compliance documentation is highly beneficial - Experience handling high-volume case files or time-sensitive administrative processes - Strong understanding of compliance-driven environments and regulatory documentation standards - Highly detail-oriented with the ability to manage strict deadlines and multiple resident files simultaneously - Experience working with nursing homes, skilled nursing facilities, or long-term care facilities (advantageous) - Comfortable working within digital systems and maintaining accurate electronic records - Proficient in MS Office and Outlook - Excellent written and verbal English communication skills Requirements - Working Hours: Monday – Friday | 8:00 AM – 5:00 PM EST (2:00 PM – 11:00 PM South African time – subject to daylight savings) - Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA) - Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered - Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered - Work Environment: Fully remote Company Description

• Act as the primary mortgage audit SME during onboarding, pilots, and go-live phases. • Conduct end-to-end QC validation across income, assets, credit, appraisal, compliance, and closing documentation. • Present audit findings clearly to customers and explain system outputs in underwriting language. • Translate underwriting and QC checklists into structured automation workflows. • Work with Product and Engineering to clarify guideline logic, exception handling, and calculation methodologies. • Validate AI-generated audit outputs and flag discrepancies. • Ensure customer work is delivered accurately and within defined SLAs. • Partner with India-based audit and DP teams to ensure consistent interpretation of guidelines. • Identify gaps between customer guidelines and platform behavior. • Support smooth transition from pilot to scaled delivery. • Drive continuous process improvement and feedback loops.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis. - Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. - Identify coding discrepancies and formulate suggestions for improvement. - Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. - Work with the Office of the CMO and provider leadership to identify and assist providers with coding. - Report findings and recommendations to Compliance Officer or designee, management, and executive leadership. - Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding. - Support compliance policies with government (Medicare & Medicaid) and private payer regulations. - Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines. - Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. - Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested. - Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments. - Assist Director of Compliance with incidents and investigations involving coding and/or documentation. - Work closely with all other Compliance personnel to provide coding/compliance support. - Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates. - Provide training to billing coding staff on coding compliance. - Participate in special projects and perform other duties as assigned. Qualifications - High school diploma or equivalent. - 5 years of healthcare experience. - 4 years of procedural and diagnostic coding. Requirements - AAPC Certified Professional Coder (CPC) certification OR Certified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA) upon hire. Knowledge/Skills/Abilities - Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims. - Knowledge in correct application of SNOMED, SNODENT, and LOINC. - Knowledge of medical terminology, disease processes, and pharmacology. - Strong attention to detail and accuracy. - Excellent verbal, written, and communication skills. - Excellent organizational skills. - Ability to multi‐task. - Proficient in Microsoft Office Suite. - Critical thinking/problem solving. - Ability to provide data and recommend process improvement practices.

Serve as the primary coordinator for patient cases, ensuring smooth progression from referral through therapy completion. Support specialty pharmacy operations by completing prior authorization documentation, scheduling medication deliveries, and facilitating document retrieval within required timelines. Responsibilities - Provide exceptional customer service in a phone-based environment, offering clear communication and empathetic support. - Perform claim adjudication tasks including prior authorizations, billing, and eligibility checks, which may require outbound calls. - Collaborate with pharmacists, technicians, and healthcare professionals to resolve patient issues and maintain continuity of care. - Conduct welcome calls and outreach to help new patients successfully onboard and establish trust. - Maintain accurate, organized patient records from initial contact through benefit verification, therapy initiation, follow-up, and case closure. - Use multiple software platforms to manage authorizations, medication profiles, and patient communication. - Assist with patient questions and serve as backup during high-volume periods. - Identify and document case concerns, escalations, or process gaps for leadership review. - Uphold patient confidentiality and follow internal policies and accreditation standards. - Complete additional duties as assigned. Required Qualifications - High school diploma or equivalent. - Registered Pharmacy Technician licensure in AL, FL, TN, MT, OH, TX, or NY. - Minimum of 2 years of healthcare or specialty pharmacy experience. - Strong computer proficiency including Windows, Excel, and Word. - Comfortable working in a phone-based environment with strong verbal and written communication skills. - Ability to work independently and collaboratively while staying organized in a fast-paced environment. Preferred Qualifications - National Certified Pharmacy Technician (PTCB). - Willingness to obtain registration in additional states. - Knowledge of pharmacy terminology, insurance processes, medical terminology, and basic pharmaceutical law. 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. For this position, we anticipate offering an hourly rate of 20 - 30 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. 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 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. 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.