Quality Review and Audit Analyst – Remote
Core
Evaluate complex medical conditions, determine compliance of medical documentation, and identify trends to support Continuous Quality Improvement (CQI) in Risk Adjustment programs.
Role type
Quality Review and Audit Analyst (Medical Coding)
Builds
Risk Adjustment data accuracy and compliance for Cigna IFP programs
Domain
Healthcare administration and medical risk adjustment
Required skills
Medical coding (ICD-10-CM), HCC coding, medical documentation audits, risk adjustment protocols, data abstraction, compliance analysis
Preferred skills
Longitudinal data thinking, vendor coding partner management, CMS/HHS regulations knowledge, medical claims submission understanding
Technologies
Excel, MS Word, Adobe Acrobat
Responsibilities
Conduct medical records reviews with accurate diagnosis code abstraction; Utilize HHS Risk Adjustment Model to confirm HCC accuracy; Perform documentation and data audits to identify gaps and compliance risks; Collaborate with partners to facilitate coding and Risk Adjustment education; Coordinate with stakeholders to execute compliant RA programs; Develop and implement internal program processes ensuring CMS/HHS compliance
