Quality Review and Audit Analyst
Cigna · Remote (US)
- Remote quality review role with Cigna in the IFP risk adjustment team.
- Evaluate complex medical conditions and determine the compliance of medical documentation.
- Conduct medical records reviews with accurate diagnosis code abstraction under official coding guidelines.
- Use the HHS Risk Adjustment Model to confirm Hierarchical Condition Category accuracy from ICD-10-CM diagnosis codes.
- Perform documentation and data audits, spotting gaps, inaccuracies and compliance risks, including RADV audits.
- Coordinate with internal and external partners on coding and risk adjustment education.
- A high school diploma and preferably two years of experience with a coding certification such as CPC, CCS-P, CCS-H, RHIT, RHIA or CRC.
Tailor your resume to this job
Have the fairy's AI rewrite your resume to match this exact job - handled personally and delivered to your private chat with the owner.