Quality Review and Audit Analyst - Cigna Healthcare - Remote
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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.
Key Job Functions
- 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.
Education & Certification
- 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.
Minimum Qualifications
- 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
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.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.