The primary job function of the Quality Review and Audit Analyst is to review the work completed by medical coders and the Health Assessment Providers for accuracy of medical records and make recommendations to coders and healthcare providers according to the ICD10-CM HCC’s guidelines.

This position is with Evernorth, a new business within the Cigna Corporation. 

This role is Work from Home which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite. 

Duties & Responsibilities:

• Make sure all documentation for completed assessments has been received
• Review each HRA template and the master document for coding accuracy
• Performs the monthly quality review for each coder based on standards operations procedures for quality review and auditing
• Quality review done monthly for 10% of all completed assessments for each coder
• Delivers professional activities related to quality review and auditing
• Provides standard professional advice and creates initial reports/analyses for review
• Develops and distributes audit reports
•  Assists with third party audits by completing questionnaires, validating selected claims, responding to errors
• Identifies and recommends changes to improvements in department processing and procedures, and assists in the development of audit guidelines
• Acts as subject matter expert and a resource for team members
• Develops and/or recommend training programs to address error trends
• Provides guidance, coaching, and direction to more junior members of the team in Quality Review and Audit
• Review assessments for accuracy and assign ICD 10 –CM/HCC’s guideline
• Send completed exam to corresponding vendor/client
• Maintains productivity between 25-30 charts reviewed daily
• Maintains coding accuracy of 95% on a monthly basis
• Communicates with providers on documentation related issues
• Communicates with Coding Director
• Maintains current their coding certification
• Explore new certifications as required by the organization
• Participates in coding trainings, conferences as offered by the organization
• Completes additional projects as distributed to the coding team
• Helps with any additional requests from Medical Directors, and Coding Director

Knowledge, Skills & Abilities:

• Certified Professional Coder with AAPC/AHIMA
• ICD-10 Certified
• Excel proficiency
• Coding experience at least 5 years
• High school diploma or general education (GED)
• Ability to read and comprehend simple instructions, short correspondence and memos
• Ability to write simple correspondence
• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions
• Strong knowledge of NextGen EPM & EMR system. 
• Experience in Microsoft products such as Word, Excel, Outlook, Internet Explorer

Competencies

• Problem Solving
• Time Management
• Team Work
• Quality Management
• Organization Support
• Dependability
• Quality
• Quantity
• Technical Skills

Certifications:

• HIPAA Certified
• CPC certificate or corresponding certificate from a reputable coding organization –AAPC, AHIMA
• ICD-10 Certified
• CRC certification a plus

Work Environment

• Work setting is primarily work at home setting with requirements of sitting with some standing involved.

Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation. 

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.