Individual & Family Plans (IFP) Quality Review & Audit Lead Analyst - Remote - Cigna Healthcare

The Quality Review and Audit Lead Analyst will be instrumental in serving as a key subject matter expert in HHS risk adjustment regulations and coding policy for both Cigna's internal teams as well as value-based provider partnerships to drive a standard of excellence in risk validation accuracy, compliance and engagement.

Works in conjunction with coding audit oversight & compliance, Global Data & Analytics, network & contracting and provider relations to develop, implement and manage a detailed and thorough Affordable Care Act, Health and Human Services (HHS) risk adjustment education & training program for both internal coding teams, internal matrix partners and value-based provider groups.

The ideal candidate will have experience and understanding of HHS risk adjustment rules & regulations, coding guidelines, provider practice negotiations, relationship building, program strategy & execution and be familiar with value-based reporting metrics and HCC analysis.

Core Responsibilities:


* Work across multiple teams to drive performance and provide support, feedback, education and training on value-based metrics specific to risk adjustment.


* Develop, implement, and maintain risk adjustment training and informative material and present to a broad range of audiences including current employees, executive and senior leadership and value-based care partners.


* Support reporting distribution and deploying of education efforts to increase provider knowledge, adoption and awareness of risk adjustment metrics and clinical/business impacts.


* Responsible for supporting partnerships with medical & market leaders, both internally and externally, to develop programs/incentives for more accurate, complete and compliant risk capture.


* Demonstrated ability to work in multi-disciplinary team environments and forge strong interpersonal relationships with peers/providers.


* Develop coding curriculum and training materials and ensure annual up to date coding guidelines.


* Collaborate internally to support risk adjustment compliance including policy updates, facilitating compliance meetings and developing new policies.


* Research and stay current to report on coding guidelines, coding clinic updates, RADV protocols and defined best practices.


* Collaborate with peers for ongoing HCC educational development while introducing innovative ideas and implementing new technologies to better support value-based programs and quality outcomes.


* Ability to work independently, meet required timelines and perform at the highest standards of excellence.


* Perform other related duties as necessary.

Minimum Qualifications:


* Bachelor's degree in health care, nursing, business management or related field


* HHS / ACA Risk Adjustment knowledge preferred


* Experience in claims processing and revenue cycle management is preferred.


* Present a professional image and exhibit strong delivery and presentation...