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

The Quality Review and Audit Lead Analyst will be instrumental in serving as a key subject matter expert in HHS risk adjustment regulations and coding policy for both Cigna’s internal teams as well as value-based provider partnerships to drive a standard of excellence in risk validation accuracy, compliance and engagement.

Works in conjunction with coding audit oversight & compliance, Global Data & Analytics, network & contracting and provider relations to develop, implement and manage a detailed and thorough Affordable Care Act, Health and Human Services (HHS) risk adjustment education & training program for both internal coding teams, internal matrix partners and value-based provider groups. 

The ideal candidate will have experience and understanding of HHS risk adjustment rules & regulations, coding guidelines, provider practice negotiations, relationship building, program strategy & execution and be familiar with value-based reporting metrics and HCC analysis.

Core Responsibilities:

• Work across multiple teams to drive performance and provide support, feedback, education and training on value-based metrics specific to risk adjustment.
• Develop, implement, and maintain risk adjustment training and informative material and present to a broad range of audiences including current employees, executive and senior leadership and value-based care partners.
• Support reporting distribution and deploying of education efforts to increase provider knowledge, adoption and awareness of risk adjustment metrics and clinical/business impacts.
• Responsible for supporting partnerships with medical & market leaders, both internally and externally, to develop programs/incentives for more accurate, complete and compliant risk capture.
• Demonstrated ability to work in multi-disciplinary team environments and forge strong interpersonal relationships with peers/providers.
• Develop coding curriculum and training materials and ensure annual up to date coding guidelines.
• Collaborate internally to support risk adjustment compliance including policy updates, facilitating compliance meetings and developing new policies.
• Research and stay current to report on coding guidelines, coding clinic updates, RADV protocols and defined best practices.
• Collaborate with peers for ongoing HCC educational development while introducing innovative ideas and implementing new technologies to better support value-based programs and quality outcomes.
• Ability to work independently, meet required timelines and perform at the highest standards of excellence.
• Perform other related duties as necessary.

Minimum Qualifications:

• Bachelor’s degree in health care, nursing, business management or related field
• HHS / ACA Risk Adjustment knowledge preferred
• Experience in claims processing and revenue cycle management is preferred.
• Present a professional image and exhibit strong delivery and presentation capabilities for both internal/external partners and associates.
• Minimum 5 years’ experience in coding, risk adjustment revenue/policy adherence and/or physician practice management
• Experience in a clinical field or practice management background/credentials strongly preferred
• Demonstrate a high degree of professionalism, enthusiasm and initiative
• Strong computer competency with Microsoft Outlook, Excel, Word, PowerPoint, Adobe Acrobat and other software applications as applicable
• Strong verbal and written communication skills with peers, partners, and providers coupled with proven leadership acumen.
• Must be detail oriented, self-motivated, and have excellent organization and project management skills
• Coding certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) required in one of the following: 

*Certified Professional Coder (CPC)     

*Certified Coding Specialist for Providers (CCS-P)

*Certified Professional Compliance Officer (CPCO)

*Registered Health Information Technician (RHIT)

*Registered Health Information Administrator (RHIA)

*Certified Risk Adjustment Coder (CRC)

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 67,200 - 112,000 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated