Individual & Family Plans (IFP) Quality Review and Audit Analyst - Remote - Cigna Healthcare

The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical 
Condition Category expertise to the role, evaluates complex medical conditions, determines 
compliance of medical documentation, identifies trends, and suggests improvements in data and 
processes for Continuous Quality Improvement (CQI).

Key Job Functions:

•  Conduct medical records reviews with accurate diagnosis code abstraction in accordance with 
Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS 
Protocols and any additional applicable rule set.
•  Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories 
(HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
•  Apply longitudinal thinking to identify all valid and appropriate data elements and 
opportunities for data capture, through the lens of HHS’ Risk Adjustment.
•  Perform various documentation and data audits with identification of gaps and/or inaccuracies in 
risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) 
programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis 
submission program. Inclusive of Quality Audits for vendor coding partners.
•  Collaborate and coordinate with team members and matrix partners to facilitate various aspects 
of coding and Risk Adjustment education with internal and external partners.
•  Coordinate with stake holders to execute efficient and compliant RA programs, raising any 
identified risks or program gaps to management in a timely manner.
•  Communicate effectively across all audiences (verbal & written).
•  Develop and implement internal program processes ensuring CMS/HHS compliant programs, including 
contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed.

Education & Experience:

The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience 
in one of the following Coding Certifications by either the American Health Information Management 
Association (AHIMA) or the American Academy of Professional Coders (AAPC):
o Certified Professional Coder (CPC)
o Certified Coding Specialist for Providers (CCS-P)
o Certified Coding Specialist for Hospitals (CCS-H)
o Registered Health Information Technician (RHIT)
o Registered Health Information Administrator (RHIA)
o Certified Risk Adjustment Coder (CRC) certification or ability to obtain certification within 6 months 
of hire.

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 annual salary of 25 - 38 USD / yearly, 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 considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, ge