Quality Review and Audit Analyst – Individual & Family Plans
The Cigna Group
full-time
Posted on:
Location Type: Remote
Location: Remote • Alabama, Alaska, Arizona, Florida, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Missouri, New York, Ohio, Pennsylvania, Texas, Utah, Vermont, Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $25 - $38 per hour
Job Level
JuniorMid-Level
About the role
- Conduct medical records reviews with accurate diagnosis code abstraction
- Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories
- Apply longitudinal thinking to identify all valid and appropriate data elements for data capture
- Perform various documentation and data audits with identification of gaps in risk adjustment data
- Collaborate and coordinate with team members and matrix partners for coding and Risk Adjustment education
- Coordinate with stakeholders to execute efficient and compliant RA programs
- Communicate effectively across all audiences
- Develop and implement internal program processes ensuring CMS/HHS compliant programs
Requirements
- high school diploma
- at least 2 years’ experience in one of the following Coding Certifications by either 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)
- 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
- HCC coding experience preferred
- computer competency with excel, MS Word, Adobe Acrobat
- must be detail oriented, self-motivated, and have excellent organization skills
- understanding of medical claims submissions is preferred
- ability to meet timeline, productivity, and accuracy standards.
Benefits
- medical, vision, dental, and well-being and behavioral health programs
- 401(k) with company match
- company paid life insurance
- tuition reimbursement
- a minimum of 18 days of paid time off per year
- paid holidays
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
ICD-10-CM codingmedical documentation auditsmedical chart reviewscoding complianceRisk Adjustment ModelHCC codingdata capturediagnosis code abstractiondata auditsmedical claims submissions
Soft skills
detail orientedself-motivatedexcellent organization skillseffective communicationcollaborationcoordinationlongitudinal thinkingidentification of gapsexecution of programsmeeting productivity standards
Certifications
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)