Quality Review and Audit Analyst

🔥 3 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Conduct medical records reviews and accurately abstract diagnosis codes according to Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols, and applicable rule sets • Use the HHS Risk Adjustment Model to confirm Hierarchical Condition Categories identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year • Apply longitudinal thinking to identify valid data elements and data-capture opportunities under HHS Risk Adjustment • Perform documentation and data audits, identify gaps, inaccuracies, and compliance risks in Risk Adjustment programs • Support Risk Adjustment Data Validation (RADV) audits and the Supplement Diagnosis submission program • Conduct quality audits for vendor coding partners • Collaborate with team members and matrix partners on coding and Risk Adjustment education for internal and external partners • Coordinate with stakeholders to execute efficient and compliant Risk Adjustment programs and raise risks or program gaps to management • Develop and implement internal program processes ensuring CMS/HHS compliance • Contribute to Cigna IFP Coding Guideline updates and policy determinations as needed • Communicate effectively across verbal and written audiences

🎯 Requirements

• High school diploma • Prefer 2 years’ experience in one of the listed AHIMA or AAPC coding certifications • Coding certification such as CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC • Individuals with a certification other than CRC must become CRC certified within 6 months of hire • Experience with medical documentation audits and medical chart reviews • Proficiency with ICD-10-CM coding guidelines and conventions • Familiarity with CMS regulations for Risk Adjustment programs and documentation and coding compliance policies, including Inpatient and Outpatient documentation • HCC coding experience preferred • Computer competency with Excel, MS Word, and Adobe Acrobat • Detail oriented, self-motivated, and excellent organization skills • Understanding of medical claims submissions preferred • Ability to meet timeline, productivity, and accuracy standards • If working at home occasionally or permanently, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work arrangement • Work-at-home internet service requirement with at least 10Mbps download/5Mbps upload via cable broadband or fiber optic provider • Reasonable accommodation support for the online application process • Tobacco-free policy • Equal employment opportunity protections