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

The Quality Review & Audit Senior Analyst ("Analyst") exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in support of the HHS' Risk Adjustment (RA) program and Risk Adjustment Data Validation (RADV) audits.

The Senior Analyst is responsible for all aspects of auditing medical documentation for diagnostic code abstraction, and possesses HHS' Hierarchical Condition Category (HCC) expertise, evaluating data accuracy and record compliance, executing on audit requirements, and identifying and recommending process improvements within the RA program.

Core Responsibilities:


* Proficient in assigning accurate ICD-10 diagnosis codes in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines , and HHS' RADV Protocols


* Audits accuracy of abstracted diagnostic codes from identified medical record cohorts, evaluating work of peers and coding vendor coders, to ensure compliance with quality standards, scoring as appropriate per monthly quality feedback reports or other scoring instrument, as defined per policy.


* Performs claims matching and auditing, as required, identifying missing or inaccurate data within RA claims and ensuring compliance with HHS' RA program protocols.


* Leads, trains, or mentors junior team members, as required, sharing expertise in RA programs.


* Contributes to execution of Risk Adjustment programs, and other IFP programs, as needed, to ensure accurate and compliant data submissions.


* Collaborates and coordinates with stakeholders to facilitate coding and risk adjustment education.


* Contributes expertise to creation and maintenance of Coding Guidelines and Best Practices, as needed.


* Participates in RADV execution for designated markets, including but not limited to, medical records reviews; subordinate, peer, or vendor coding audits; evaluation and reporting of progress, barriers, or errors; or other tasks as defined in HHS' RADV Protocols.

Minimum Qualifications:


* High School Diploma or equivalent; Bachelors or equivalent work experience preferred


* 5+ years' experience in medical record coding, with certification in good standing from either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), in one or more of the following:


* Certified Professional Coder (CPC)


* Certified Coding Specialist for Providers (CCS-P)


* Certified Coding Specialist for Hospitals (CCS-H)


* Registered Health Information Technician (RHIT)


* Registered Health Information Administrator (RHIA)


* Certified Risk Adjustment Coder (CRC)or able to obtain within 12 months of hire, if not previously certified

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

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