Remote Risk Adjustment Quality Analyst

The Cigna Group; Franklin (TN); Remote; USD 33,000 - 37,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K

Job summary

The Cigna Group is seeking a Quality Review and Audit Analyst for a fully remote role supporting Risk Adjustment within the IFP program. The candidate will apply medical coding expertise to review complex conditions, ensure documentation compliance, and identify improvement opportunities in data and processes for CQI.

Responsibilities include conducting records reviews, validating HCC accuracy, performing audits for RADV and supplementary submissions, and collaborating with internal and external

Qualifications

• Two+ years' experience with medical documentation audits and ICD-10-CM coding guidelines and conventions.
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance.
• HCC coding experience.
• Proficiency with Excel, Word, and Acrobat for documentation and audits.

Responsibilities

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions.
• Utilize HHS Risk Adjustment Model to confirm accuracy of HCC identified from ICD-10-CM codes.
• Apply longitudinal thinking to identify data elements and opportunities for data capture within HHS Risk Adjustment.
• Perform data audits identifying gaps and compliance risks in RA programs and RADV workflows.
• Collaborate with team members and partners to support coding and Risk Adjustment education.
• Coordinate with stakeholders to execute compliant RA programs and raise risks to management.

Skills

Risk Adjustment

HHS Risk Adjustment

Education

CPC

CCS-P

CCS-H

RHIT

RHIA

CRC certification

Tools

Excel

MS Word

Adobe Acrobat

Job description

The Cigna Group is seeking a Quality Review and Audit Analyst for a fully remote role supporting Risk Adjustment within the IFP program. The candidate will apply medical coding expertise to review complex conditions, ensure documentation compliance, and identify improvement opportunities in data and processes for CQI.

Responsibilities include conducting records reviews, validating HCC accuracy, performing audits for RADV and supplementary submissions, and collaborating with internal and external