Quality Review and Audit Analyst

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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 with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions • Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education • Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data • Communicate effectively across all audiences (verbal & written) • Develop and implement internal program processes ensuring CMS/HHS compliant programs

🎯 Requirements

• High school diploma • 2+ years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC): 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) certification • 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 policies related to documentation and coding compliance • Understanding of medical claims submissions is preferred • Ability to meet timeline, productivity, and accuracy standards • Must be detail oriented, self-motivated, and have excellent organization skills

🏖️ Benefits

• Health insurance • Vision insurance • Dental insurance • 401(k) • Company paid life insurance • Tuition reimbursement • A minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence