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Quality Review and Audit Analyst – Remote at Cigna Healthcare - ApplyBlast

Quality Review and Audit Analyst – Remote

Cigna Healthcare

3 months ago

Texas

Hybrid

Full Time

Senior

0 applicants

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About this role

The Risk Adjustment Quality & Review Analyst evaluates complex medical conditions and determines compliance of medical documentation to support Continuous Quality Improvement. The role involves conducting medical record reviews, utilizing the HHS Risk Adjustment Model, and performing audits to identify data gaps and compliance risks. Analysts collaborate with internal and external partners to execute efficient Risk Adjustment programs and suggest process improvements.

Responsibilities

Conduct medical records reviews with accurate diagnosis code abstraction
Utilize HHS Risk Adjustment Model to confirm HCC accuracy
Perform documentation and data audits to identify compliance risks
Collaborate with partners to facilitate coding and Risk Adjustment education
Develop and implement internal program processes ensuring CMS compliance

Skills

Qualifications

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)