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Quality Review and Audit Analyst
The Cigna GroupRisk Adjustment Quality & Review Analyst at Cigna conducting medical coding reviews and improving data processes for risk adjustment programs. Collaborating with teams and contributing to quality audits and training.
About the role
Key responsibilities & impact- conduct medical records reviews with accurate diagnosis code abstraction
- utilize HHS’ Risk Adjustment Model
- apply longitudinal thinking to identify data elements
- perform documentation and data audits
- collaborate with team members and matrix partners
- coordinate with stakeholders for efficient RA programs
- communicate effectively
- develop and implement internal program processes
Requirements
What you’ll need- high school diploma
- at least 2 years’ experience in medical coding
- Coding Certifications by AHIMA or AAPC: CPC, CCS-P, CCS-H, RHIT, RHIA, 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
- computer competency with excel, MS Word, Adobe Acrobat
- detail-oriented, self-motivated, and excellent organization skills
- understanding of medical claims submissions preferred
- ability to meet timeline, productivity, and accuracy standards
Benefits
Comp & perks- 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
ATS Keywords
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Hard Skills & Tools
medical codingICD-10-CM codingdiagnosis code abstractiondata auditsmedical documentation auditsmedical chart reviewslongitudinal thinkingdata elements identificationprogram processes developmentprogram processes implementation
Soft Skills
detail-orientedself-motivatedexcellent organizationeffective communicationcollaborationstakeholder coordination
Certifications
CPCCCS-PCCS-HRHITRHIACRC