Individual & Family Plans (IFP) Quality Review & Audit Lead Analyst - Remote - Cigna Healthcare

Primary Functions:

Works in conjunction with coding audit oversight & compliance, Global Data & Analytics, network & contracting and provider relations to develop, implement and manage a detailed and thorough risk adjustment coding education & training program for both internal coding teams and value-based provider partners. 

The ideal candidate will have experience and understanding of risk adjustment rules & regulations, coding guidelines, provider practice negotiations, relationship building, program strategy & execution and be familiar with value-based reporting metrics and HCC analysis.

The Quality Review and Audit Lead Analyst will be 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 value-based provider partnerships to drive a standard of excellence in risk validation accuracy, compliancy and engagement.

Core Responsibilities:

• Work across multiple teams to drive performance and provide support, feedback, education and training on value-based metrics specific to risk adjustment.
• Develop coding curriculum and training materials and ensure annual up to date coding guidelines.
• Collaborate internally to support risk adjustment compliance including policy updates, facilitating compliance meetings and developing new policies.
• Research and stay current to report on coding guidelines, coding clinic updates, RADV protocols and defined best practices.
• Develop, implement, and maintain risk adjustment trainings and informative material and present to a broad range of audiences including current employees, executive and senior leadership and value-based care partners.
• Support reporting distribution and deploy education efforts to increase provider knowledge, adoption and awareness of risk adjustment metrics and clinical/business impacts.
• Collaborate with peers for ongoing HCC educational development while introducing innovative ideas and implementing new technologies 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.
• Ability to work independently, meet required timelines and perform at the highest standards of excellence.
• Perform other related duties as necessary.

Minimum Qualifications:

• Bachelor’s degree in health care, nursing, business management or related field
• HHS / ACA Risk Adjustment knowledge preferred
• Experience in claims processing and revenue cycle management is preferred.
• Present a professional image and exhibit strong presentation capabilities for both internal/external partners and associates.
• Minimum 5 years’ experience in coding, risk adjustment revenue/policy adherence and/or physician practice management
• Experience in a clinical field or practice management background/credentials 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)
• Demonstrate 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

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 65,600 - 109,400 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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