Individual & Family Plans (IFP) Quality Review and Audit Lead Representative - Remote - Cigna Health

Job Summary:

The position supports Cigna's Risk Adjustment program and is responsible for medical record chart retrieval and administration.

The Lead Representative is responsible for prioritization, training, mentoring, auditing, and problem-solving issues pertaining to retrieving and processing medical records.

Core Responsibilities:


* Monitors all chart retrieval activities for IFP projects, and performs such actions as defined by department workflows, including tasks such as tracking outstanding records, analyzing barriers to retrieval, evaluating chart availability, reviewing for completeness & image quality, routing charts to the appropriate location, problem solving with retrieval vendors, and recording activities in the designated application.


* Performs outreach via telephone or secure fax to provider offices for requests including but not limited to additional information required, record delivery, retrieved record deficiencies, and signature deficiency attestation completion, as needed.


* Day to day quality audits on vendor chart records, responses, provider engagement, and related requirements.


* Ensures confidentiality and security of Cigna customer PPI/PHI by following all HIPAA, regulatory, and Cigna processes and release-of-information protocols.


* Follows Cigna medical records policies for storage and retention.


* Maintains a daily production tracker, or other reporting, in a predetermined format and cadence.


* Performs chart processing, vendor pend resolution, provider research, and other tasks as required to execute on IFP Risk Adjustment programs.


* Develops & leads new training as existing chart retrieval audit processes evolve or change.


* Acts as 2nd in command for day-to-day operations in the event that the CA & Interop supervisor is on PTO or needs coverage in meetings.

Minimum Qualifications:


* High School Diploma or equivalent


* One (1) to three (3) years of chart retrieval experience or similar job history


* Knowledge of compliant medical records, including basic medical terminology


* Intermediate knowledge of Microsoft Excel, Outlook management, Adobe and Word


* Ability to determine when escalations are required to resolve issues.


* Ability to work as a team and individually on time-sensitive projects


* Ability to perform work in an accurate and timely manner.


* Must be detail oriented, able to multi-task, accurate in data entry, able to follow directions, and apply criteria for multiple measures


* General understanding of healthcare privacy regulations


* Demo nstrates clear, concise, and professional communications with peers and supervisors, in verbal, telephonic, and written communication.


* Demonstrates the ability to follow workflows independently as required.


* Prior experience with working with medical records preferred


* Prior experience with working with EMR/EHR systems preferred, but not requir...