Quality Review and Audit Analyst

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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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

• Conduct medical records reviews with accurate diagnosis code abstraction • Utilize HHS’ Risk Adjustment Model to confirm accuracy of HCC • Identify data elements and opportunities for capture • Perform documentation and data audits • Collaborate with team members and partners for coding and Risk Adjustment education • Coordinate with stakeholders for efficient RA programs • Communicate effectively across all audiences • Develop and implement program processes ensuring CMS/HHS compliance

🎯 Requirements

• High school diploma • Prefer 2 years’ experience with Coding Certifications by AHIMA or 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) • CRC certification required within 6 months of hire if not already held • Experience with medical documentation audits and chart reviews • Proficiency with ICD-10-CM coding guidelines • Familiarity with CMS regulations for Risk Adjustment programs • 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 productivity and accuracy standards.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Remote work options • Professional development opportunities