[Hiring] Quality Review and Audit Analyst @Cigna Healthcare

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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.