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Quality Review and Audit Analyst(Remote) ID-14035

About the position

The Risk Adjustment Quality & Review Analyst at Cigna Group is responsible for evaluating complex medical conditions and ensuring compliance with medical documentation. This role involves conducting medical records reviews, identifying trends, and suggesting improvements for Continuous Quality Improvement (CQI) in risk adjustment programs. The analyst will utilize coding expertise to confirm the accuracy of Hierarchical Condition Categories (HCC) and collaborate with various stakeholders to enhance coding education and compliance.

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Responsibilities

  • Conduct medical records reviews with accurate diagnosis code abstraction according to coding guidelines.
  • Utilize HHS' Risk Adjustment Model to confirm accuracy of HCC identified from abstracted ICD-10-CM diagnosis codes.
  • Apply longitudinal thinking to identify valid data elements and opportunities for data capture.
  • Perform documentation and data audits to identify gaps and compliance risks in risk adjustment data.
  • Collaborate with team members and partners to facilitate coding and Risk Adjustment education.
  • Coordinate with stakeholders to execute efficient and compliant RA programs, raising identified risks to management.
  • Communicate effectively across all audiences, both verbal and written.
  • Develop and implement internal program processes ensuring CMS/HHS compliance.

Requirements

  • High school diploma and at least 2 years of experience in medical coding or related field.
  • Certification from AHIMA or AAPC (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC).
  • Experience with medical documentation audits and proficiency with ICD-10-CM coding guidelines.
  • Familiarity with CMS regulations for Risk Adjustment programs and policies.
  • HCC coding experience preferred.
  • Computer competency with Excel, MS Word, and Adobe Acrobat.
  • Detail-oriented, self-motivated, and excellent organizational skills.
  • Understanding of medical claims submissions preferred.

Nice-to-haves

  • Experience with HCC coding is preferred.
  • Proficiency in using Excel and other office software.

Benefits

  • Medical, vision, and dental insurance starting on day one.
  • 401(k) with company match.
  • Company paid life insurance.
  • Tuition reimbursement.
  • A minimum of 18 days of paid time off per year.
  • Paid holidays.
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