Medicare Risk Adjustment Analytics Advisor

WORK LOCATION: Hybrid - if live close to a Cigna Office [potential for Remote if do not live near a Cigna Office]

We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team.

The Risk Adjustment and Stars Enablement team is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems.

The Medicare Risk Adjustment Analytics Advisor would be a member of the Risk Adjustment and Enablement team that provides support by leveraging multiple data domains to answer important business questions.

This position is connected with multiple teams to ensure that data is reviewed, explained and reported to measure success for Risk Adjustment Enablement projects.

This position will have a primary focus on supporting Risk Adjustment compliance and audit projects.

Principal Duties:


* Perform required tracking and reporting for all Risk Adjustment overpayments including: identification, actuarial valuation, submission to CMS, processing by CMS, and reconciliation.


* Answering questions for external counsel and compliance partners to support overpayment reporting and managing reconciliation reporting of all requested risk adjustment deletes.


* Assists in the analysis and reporting solutions which address Risk Adjustment compliance and audit business needs.


* Identify and analyze user requirements, procedures and prepares detailed specifications from which analysis and reports will be written.


* Analyzes and revises existing reporting logic difficulties and documentation as necessary.


* Competent to work on any phase of the team Risk Adjustment analysis project activities.


* Leverage data and predictive analysis to clearly articulate problems and influence decisions that support the strategic direction.


* Communicate key information to Compliance and Audit partners for awareness of trends, processes, and Risk Adjustment issues.


* Working closely with Compliance, Audit, Actuary and other data domain leaders that share Risk Adjustment responsibilities.


* Reviewing, researching, investigating and correcting issues through data and process analysis.


* Develop collaborative relationships with internal partners to ensure Risk Adjustment goals are met.


* Analyze the integrity of data, diagnose issues and test changes.


* Participates in change management procedures to support accurate Risk Adjustment team documentation and process flows supporting processes and requirements.


* Maintain reporting describing results against internal goals; presenting results and updates to leadership.


* Resolve issues and problems by conferring with both internal and external partners as necessary.


* Other duties as assigned by supervisor/organizational leadership.


* Maintain professional contact with other departments as needed; attend interdepartmental meetings.

Qualifications Required:


* Bachelor's Degree require...