Quality Review and Audit Analyst

🔥 0 minutes 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 record reviews and accurately abstract diagnosis codes according to Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS protocols, and other applicable rules • 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 opportunities for data capture under HHS Risk Adjustment • Perform documentation and data audits to identify gaps, inaccuracies, and compliance risks in IFP Risk Adjustment programs • Support the Risk Adjustment Data Validation (RADV) audit and Supplement Diagnosis submission program • Conduct quality audits of 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 • Communicate effectively across verbal and written audiences • Develop and implement internal program processes ensuring CMS/HHS-compliant programs • Contribute to Cigna IFP Coding Guideline updates and policy determinations as needed

🎯 Requirements

• High school diploma • Prefer 2 years’ experience in one of the listed AHIMA or AAPC coding certifications • Certification as CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC; individuals with a non-CRC certification 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 for 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 • Home internet connection through a cable broadband or fiber optic provider with at least 10Mbps download/5Mbps upload if working at home • Qualified applicants will be considered without regard to legally protected characteristics • Qualified applicants with criminal histories will be considered consistent with applicable federal, state, and local ordinances

🏖️ Benefits

• Remote work arrangement • Work-at-home internet service requirement/support for cable broadband or fiber optic connection with at least 10Mbps download/5Mbps upload • Tobacco-free policy (policy/condition of employment, not an employee benefit)