Individual & Family Plans (IFP) Quality Review & Audit Sr. Representative - Remote - Cigna Healthcare

Job Summary:

The position supports Cigna's Risk Adjustment program and is responsible for medical record chart retrieval and administration.  This role is responsible for auditing, and problem-solving issues pertaining to retrieving and processing medical records. 

Core Responsibilities:

• Monitors all chart retrieval activities for C+O projects, and performs actions as defined by department workflows, including tracking outstanding records, analyzing barriers to retrieval, evaluating chart availability, reviewing for completeness & image quality, routing charts to the appropriate location, problem solving with retrieval vendors, and recording activities in the designated application.
• Performs outreach via telephone or secure fax to provider offices for requests including but not limited to additional information required, record delivery, retrieved record deficiencies, and signature deficiency attestation completion, as needed.
• Day to day quality audits on vendor chart records, responses, provider engagement, and related requirements.
• Ensures confidentiality and security of Cigna customer PPI/PHI by following all HIPAA, regulatory, and Cigna processes and release-of-information protocols.
• Follows Cigna medical records policies for storage and retention.
• Maintains a daily production tracker, or other reporting, in a predetermined format and cadence.
• Performs chart processing, vendor pend resolution, provider research, and other tasks as required to execute on C+O Risk Adjustment programs.

Minimum Qualifications:

• High School Diploma or equivalent
• Prior experience with working with EMR/EHR systems is strongly preferred, but not required.
• Knowledge of medical records, including basic medical terminology
• Strongly skilled in Microsoft Excel, Outlook management, Adobe and Word
• Ability to determine when escalations are required to resolve issues.
• Ability to work as a team and individually on time-sensitive projects
• Ability to perform work in an accurate and timely manner.
• Must be detail oriented, able to multi-task, accurate in data entry, able to follow directions, and apply criteria for multiple measures
• General understanding of healthcare privacy regulations is
• Demonstrates clear, concise, and professional communications with peers and supervisors, in verbal, telephonic, and written communication.
• Demonstrates the ability to follow workflows independently as required.
• Prior experience with working with medical records preferred
• Experience with HCC coding preferred but not required.

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 21 - 32 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.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be