This position is a temporary assignment. As a contractor, you’ll be employed by Magnit, not The Cigna Group or any subsidiaries of The Cigna Group.

Job Title: Quality Review and Audit Analyst 

LOCATION AND SCHEDULE:

Work Schedule: M-F (start time between 7am-9am EST) Starndard 8 hour day, ½ hour lunch
Training Schedule: M-F, 9am-5pm EST

This is a fully remote role open to candidates across the US.

ROLE SUMMARY

The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for Continuous Quality Improvement (CQI).

Key Job Functions:

Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set.

Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.

Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment.

Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners.

Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners.

Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner.

Communicate effectively across all audiences (verbal & written).

Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed.

SKILLS:

Risk Adjustment 

HHS Risk Adjustment

REQUIREMENTS:
2+ years' Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions 

Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation.

HCC coding experience preferred 

Computer competency with excel, MS Word, Adobe Acrobat 

Must be detail oriented, self-motivated, and have excellent organization skills 

Understanding of medical claims submissions is preferred 

Ability to meet timeline, productivity, and accuracy standards

EDUCATION:

The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC):

Certified Professional Coder (CPC)

Certified Coding Specialist for Providers (CCS-P)

Certified Coding Specialist for Hospitals (CCS-H)

Registered Health Information Technician (RHIT)

Registered Health Information Administrator (RHIA)

Certified Risk Adjustment Coder (CRC) certification

Hourly Pay Rate Range (dependent on location, experience, expectation):
The pay range that Magnit reasonably expects to pay for this position is: $24.00/hour-$27.00/hour  
Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met) 

REF: 37261716
 

Tundra Technical Solutions (the operator of this Talent Community) is a global leader of contingent talent services. Our success and our clients’ success are built on a foundation of service excellence. We are an equal opportunity employer, and we do not discriminate on the basis of race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability, genetic information, or other applicable legally protected characteristic. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law, including the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Unincorporated LA County workers: we reasonably believe that criminal history may have a direct, adverse and negative relationship with the following job duties, potentially resulting in the withdrawal of a conditional offer of employment: client provided property, including hardware (both of which may include data) entrusted to you from theft, loss or damage; return all portable client computer hardware in your possession (including the data contained therein) upon completion of the assignment, and; maintain the confidentiality of client proprietary, confidential, or non-public information. In addition, job duties require access to secure and protected client information technology systems and related data security obligations. 

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.