[Hiring] Quality Review and Audit Analyst @Cigna Healthcare
Role Description
- The Risk Adjustment Quality & Review Analyst supports IFP Risk Adjustment programs by applying medical coding and HCC expertise to review documentation, validate data accuracy, ensure compliance, and identify opportunities for continuous improvement.
- Conduct medical record reviews with accurate ICD‑10‑CM diagnosis code abstraction in alignment with official guidelines, Cigna IFP standards, HHS protocols, and applicable rule sets.
- Validate HCC assignments for the correct Benefit Year using the HHS Risk Adjustment Model.
- Perform documentation and data audits to identify errors, gaps, and compliance risks across IFP Risk Adjustment programs, including RADV and Supplemental Diagnosis submissions.
- Support vendor coding quality reviews and collaborate with partners on coding and RA education.
- Coordinate with internal and external stakeholders to ensure efficient, compliant RA program execution.
- Escalate risks promptly and communicate clearly across audiences.
- Support program processes and guideline updates to maintain CMS/HHS compliance, including contributing to Cigna IFP Coding Guideline revisions and policy decisions.
- Qualifications
- High school diploma required.
- Minimum 2 years experience with one of the following AHIMA/AAPC certifications: CPC, CCS‑P, CCS‑H, RHIT, RHIA, or CRC.
- Non‑CRC holders must obtain CRC within 6 months of hire.
- Experience with medical documentation audits and chart reviews.
- Strong knowledge of ICD‑10‑CM guidelines.
- Familiarity with CMS Risk Adjustment regulations for inpatient/outpatient documentation.
- HCC coding experience preferred.
- Proficiency with Excel, Word, and Adobe Acrobat.
- Detail‑oriented, organized, and self‑motivated.
- Understanding of medical claims submission preferred.
- Ability to meet productivity, accuracy, and timeline standards.
- Requirements
- 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.
- For this position, we anticipate offering an hourly rate of 25 - 38 USD / hourly, depending on relevant factors, including experience and geographic location.
- This role is also anticipated to be eligible to participate in an annual bonus plan.
- Benefits
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- 401(k) with company paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year and paid holidays.
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