Provider Education Data Senior Analyst- Hybrid- Chattanooga or Memphis, TN- Cigna Healthcare

Candidate must reside in Chattanooga or Memphis, TN area

Job Summary:

This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an operational market.

The role will be accountable for assigned provider groups reaching risk adjustment and stars related annual metrics.

This role will work directly with providers to assist in achieving accurate and complete coding documentation and addressing Stars gaps in care.

The role will work under the direction of Risk Adjustment & Stars Provider Education Supervisor and/or Manager to reach overall operational market goals in conjunction with market network operations, stars strategy and vendor partners.

The role will provide subject matter expertise to assigned providers and internal matrix partners of Cigna Medicare's programs specific to CMS Risk Adjustment and HCC Coding Processes.

It will require expertise in ICD-10-CM/outpatient and CPT coding principles and guidelines and use of own discretion to deliver compliant, effective strategies to meet established goals.

Core Responsibilities:


* Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups (PODs/IPAs).


* Accountable to complete and accurate review of multi-year diagnosis coding of assigned population.


* Understands, develops, tracks, monitors and reports on key program performance metrics for coding initiatives.


* Work closely with matrix partners including Network Operations, Stars or Clinical Operations, and vendors to ensure provider office communications are effective and efficient.


* Review and act on any assigned audit educational opportunities timely and provide primary care or specialty care provider trainings as necessary to educate on audit findings.


* Analyze data regarding trends or patterns identified in provider office diagnosis coding.

Implement provider office education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards.


* Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data.


* Develop relationships with clinical providers/staff and communicate coding and documentation guidelines.


* Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation.


* Conduct chart reviews for providers and review provider performance.T his is accomplished by doing virtual training sessions, traveling to the individual practices and/or performing side-by-side education.


* Assists with research, analysis and response to inquiries from all internal and external audit departments regarding compliance, coding, and inappropriate coding.


* Attend risk adju...