Coding Quality Review and Audit Advisor- Risk Adjustment Educator- Remote- Cigna Healthcare

Job Summary:

The Quality Review and Audit Advisor – Risk Adjustment Educator (“Educator”) is a program and strategy leader who coordinates with medical record Coding Audit & Compliance, Global Data & Analytics, Network & Contracting, and Provider Engagement to develop, implement, manage, and communicate a detailed Risk Adjustment education & training program for all stakeholders involved in risk adjustment coding initiatives. The ideal candidate understands risk adjustment rules & regulations, coding guidelines, value-based reporting metrics, HCC analysis, and is skilled in relationship building and developing effective presentations. The Educator is instrumental in serving as a key subject matter expert in risk adjustment regulations and coding policy for both Cigna’s internal teams as well as coding vendors to drive a standard of excellence in Risk Adjustment accuracy.

Core Responsibilities:

• Coordinates across multiple teams to drive performance and provide education and training on compliance, coding, and value-based metrics specific to risk adjustment.
• Remains current on Risk Adjustment program and Medical Record coding knowledge, through research and continuing education, to support compliant Best Practices and timely educational materials.
• Develops coding curriculum and training materials supporting Best Practices & Coding Guidelines.
• Implements, maintains, and conducts risk adjustment coding training for all new hires, current employees, coding vendors, and value-based participants.
• Supports reporting distribution and deploy education efforts to increase coder’s knowledge, adoption and awareness of risk adjustment metrics and clinical/business impacts.
• Collaborates with peers for ongoing HCC educational development while introducing, implementing new technologies and innovative ideas to better support value-based programs and quality outcomes.
• Responsible for supporting partnerships with medical & market leaders, both internally and externally, to develop programs/incentives for more accurate, complete and compliant risk capture.
• Demonstrated ability to work in multi-disciplinary team environments and forge strong interpersonal relationships with peers/providers.
• Presents a professional image and exhibits strong presentation capabilities for both internal/external partners and associates.
• Ability to work independently, meet required timelines and perform at the highest standards of excellence.
• Perform other related duties as requested.

Minimum Qualifications:

• Minimum 5 years’ experience in coding, risk adjustment revenue/policy adherence
• Previous vendor management and experience in quality assurance strongly preferred
• Coding certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) required in one of the following: 
  • Certified Professional Coder (CPC)     
  • Certified Coding Specialist for Providers (CCS-P)
  • Certified Professional Compliance Officer (CPCO)
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
  • Certified Risk Adjustment Coder (CRC)
• Demonstrates high degree of professionalism, enthusiasm and initiative
• Strong computer competency with Microsoft Outlook, Excel, Word, PowerPoint, Adobe Acrobat and other software applications as applicable
• Strong verbal and written communication skills with peers, partners, and providers coupled with proven leadership acumen.
• Must be detail oriented, self-motivated, and have excellent organization and project management skills

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

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 annual salary of 74,600 - 124,400 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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