Quality Review & Audit Analyst
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Job Description
Quality Review & Audit Analyst evaluating complex medical conditions and compliance documentation at Cigna. Collaborating with team members to ensure data accuracy and suggest process improvements.
Responsibilities:
- Conduct medical records reviews with accurate diagnosis code abstraction
- Utilize HHS’ Risk Adjustment Model to confirm accuracy of HCC
- Apply longitudinal thinking to identify valid data elements
- Perform various documentation and data audits
- Collaborate and coordinate with team members and matrix partners
- Coordinate with stakeholders to execute efficient RA programs
- Communicate effectively across all audiences
- Develop and implement internal program processes ensuring compliance with CMS/HHS
Requirements:
- High school diploma
- At least 2 years’ experience in medical documentation audits and medical chart reviews
- Proficiency with ICD-10-CM coding guidelines and conventions
- Familiarity with CMS regulations for Risk Adjustment programs
- HCC coding experience preferred
- Computer competency with Excel, MS Word, Adobe Acrobat
- Detail oriented and self-motivated
- Excellent organization skills
- Understanding of medical claims submissions is preferred
Benefits:
- Medical, vision, dental insurance
- 401(k)
- Company paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
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