Quality Review and Audit Analyst

🕒 5 days ago

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

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

• Proficient in assigning accurate ICD-10 diagnosis codes • Audits accuracy of abstracted diagnostic codes from identified medical record cohorts • Performs claims matching and auditing, identifying missing or inaccurate data within RA claims • Leads, trains, or mentors junior team members • Collaborates and coordinates with stakeholders to facilitate coding and risk adjustment education • Contributes expertise to creation and maintenance of Coding Guidelines and Best Practices • Participates in RADV execution for designated markets

🎯 Requirements

• High School Diploma or equivalent; Bachelors or equivalent work experience preferred • 5+ years’ experience in medical record coding • certification in good standing from either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), in one or more of the following: Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Risk Adjustment Coder (CRC) • Willing to achieve CRC certification within 12 months of hire, if not previously certified • Experience with Risk Adjustment coding and HCCs • Competency with MS Excel, MS Word, Adobe Acrobat, or other comparable software • Must be detail oriented, self-motivated, and have excellent organization skills • Ability to work independently, managing time to meet deadlines, timelines, productivity, and accuracy standards for program success

🏖️ Benefits

• medical, vision, dental, and well-being and behavioral health programs • 401(k) • company paid life insurance • tuition reimbursement • a minimum of 18 days of paid time off per year • paid holidays