[Hiring] Quality Review and Audit Analyst @Cigna Healthcare
Role Description
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.
• 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.
Qualifications
• 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.
• 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.
Requirements
• 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.
Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) with company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Apply Now
Apply Now
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.
• 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.
Qualifications
• 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.
• 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.
Requirements
• 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.
Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) with company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Apply Now
Apply Now