Quality Review and Audit Analyst (36131347)

The Cigna Group; United States; Remote; Full time

Job summary

The Cigna Group seeks a Quality Review and Audit Analyst for a temporary contract role, focusing on medical records reviews and compliance with coding guidelines. Candidates should have relevant coding certifications and experience, alongside strong detail orientation and communication skills, in a remote work environment.

Benefits

Medical benefits

Dental benefits

Vision benefits

401K

Qualifications

• Experience with Risk Adjustment Coding.
• Experience with medical documentation audits and chart reviews.
• Computer competency with Excel, MS Word, Adobe Acrobat.

Responsibilities

• Conduct medical records reviews according to coding guidelines.
• Perform documentation and data audits identifying compliance risks.
• Coordinate with stakeholders for efficient Risk Adjustment programs.

Skills

Attention to detail

Self-motivation

Organization skills

Communication (written and verbal)

Education

High School Diploma

Coding Certifications (AHIMA or AAPC)

Tools

Excel

MS Word

Adobe Acrobat

Job description

Quality Review and Audit Analyst (36131347)

Join to apply for the Quality Review and Audit Analyst (36131347) role at The Cigna Group

Quality Review and Audit Analyst (36131347)

Join to apply for the Quality Review and Audit Analyst (36131347) role at The Cigna Group

Get AI-powered advice on this job and more exclusive features.

This range is provided by The Cigna Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$29.00/yr - $29.00/yr

This position is a temporary assignment. As a contractor, you’ll be employed by Magnit, not The Cigna Group or any subsidiaries of The Cigna Group.

Location/Schedule Notes:

Remote, USA only. M-F 8-hour days with a start time between 7:00 AM & 9:00 AM (EST).

Responsibilities

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set
• Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
• Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment.
• Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners.
• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners.
• Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risksor program gaps to management in a timely manner.
• Communicate effectively across all audiences (verbal & written).
• Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed.
  
  

Qualifications

• Experience with Risk Adjustment Coding
• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CMcoding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
• Computer competency with excel, MS Word, Adobe Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Understanding of medical claims submissions is preferred
• Ability to meet timeline, productivity, and accuracy standards
• Excellent written and verbal communication
  
  

The Quality Review & Audit Analyst Will Have a High School Diploma And At Least 2 Years’ Experience In One Of The Following Coding Certifications By Either The American Health Information Management Association (AHIMA) Or The American Academy Of Professional Coders (AAPC)

• 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) certification
  
  

Hourly Pay Rate Range (dependent on location, experience, expectation)

The pay range that Magnit reasonably expects to pay for this position is: $22.00/hour-$29.00/hour

Benefits: Medical, Dental, Vision, 401K(provided minimum eligibility hours are met)

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Finance and Sales

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at The Cigna Group by 2x

Get notified about new Audit Analyst jobs in United States.

Staff Accountant – Fast Growing SaaS Startup - Remote

New York, NY $80,000.00-$85,000.00 1 week ago

United States $86,000.00-$101,000.00 3 days ago

United States $85,000.00-$105,000.00 2 weeks ago

United States $50,000.00-$65,000.00 1 day ago

United States $65,000.00-$75,000.00 1 week ago

United States $86,000.00-$101,000.00 4 days ago

Chicago, IL $62,000.00-$67,000.00 1 week ago

Accountant - General Ledger & Accounting Process (Healthcare)

Columbus, GA $68,000.00-$78,000.00 1 week ago

Chattanooga, TN $50,000.00-$60,000.00 2 days ago

United States $61,000.00-$72,000.00 1 week ago

United States $80,000.00-$90,000.00 2 weeks ago

District of Columbia, United States 1 week ago

United States $55,000.00-$65,000.00 1 week ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.