Quality Review and Audit Analyst

🕒 August 5

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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 record reviews and accurately abstract diagnosis codes according to applicable coding guidelines and protocols • Use the HHS Risk Adjustment Model to confirm Hierarchical Condition Categories identified from ICD-10-CM diagnosis codes for the correct Benefit Year • Apply longitudinal thinking to identify valid data elements and opportunities for data capture • Perform documentation and data audits, identifying gaps, inaccuracies, and compliance risks in risk adjustment data • Support IFP Risk Adjustment programs, including the RADV audit and Supplement Diagnosis submission program • Conduct quality audits for vendor coding partners • Collaborate with team members and matrix partners on coding and Risk Adjustment education • Coordinate with stakeholders to execute efficient and compliant Risk Adjustment programs • Raise identified risks or program gaps to management in a timely manner • Communicate effectively with all audiences verbally and in writing • Develop and implement internal program processes ensuring CMS/HHS compliance • Contribute to Cigna IFP Coding Guideline updates and policy determinations

🎯 Requirements

• High school diploma • 2+ years’ experience in medical coding, risk adjustment, or a related listed area • One of the following AHIMA or AAPC certifications: CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC • Candidates 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 • Experience with both inpatient and outpatient documentation • HCC coding experience preferred • Computer competency with Excel, MS Word, and Adobe Acrobat • Detail-oriented, self-motivated, and highly organized • Understanding of medical claims submissions preferred • Ability to meet timeline, productivity, and accuracy standards • For home working, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload is required

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement