Requires travel to provider offices in and around coverage area.
Job Summary:
This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an operational market. The role will be accountable for assigned provider groups supporting risk adjustment. This role will collaborate directly with providers to assist in achieving accurate and complete coding documentation.
Provider Data Lead Analysts will be responsible for the most complex provider groups along the engagement continuum within an assigned market. Lead Analyst will be primary contact for provider groups on Risk Adjustment at joint operating meetings, quality meetings, etc.
Lead analysts may be asked to provide coaching and support to senior analyst and coverage of meetings (including preparation) to support business needs.
The role will work under the direction of Risk Adjustment & Stars Provider Education Regional Manager in conjunction with matrix partners. The role will provide subject matter expertise to assigned providers and internal matrix partners of Cigna Medicare's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and CPT coding principles and guidelines.
Core Responsibilities:
In partnership with Risk Adjustment & Stars Provider Education Regional Manager, support the training and development of Senior Analysts.
Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups.
Accountable to complete and accurate review of multi-year diagnosis coding of assigned population.
Understands, develops, tracks, monitors, and reports on key program performance metrics supporting complete and accurate documentation.
Review and act on any assigned audit educational opportunities timely and provide primary care or specialty care provider trainings as necessary to educate on audit findings.
Analyze data regarding trends or patterns identified in provider office diagnosis coding. Implement provider office education, where necessary, and provide formal training, utilizing RA approved content to providers and staff regarding coding and documentation standards.
Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education.
Develop relationships with clinical providers/staff and communicate coding and documentation guidelines.
Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation.
Conduct chart reviews for providers and review findings utilizing company policies .T his is accomplished by traveling to the individual practices, and/or performing side-by-side education.
Assists with research, analysis, and response to inquiries from all internal and external audit departments regarding compliance, coding, and inappropriate coding.
Provides second level medical record review of external requests for diagnosis code retraction.
Attend risk adjustment and quality provider meetings for assigned provider groups to provide updates, recommendations, or education supporting complete and accurate documentation (may occur be before/after normal business hours).
Perform the coding quality reviews consistent with established departmental requirements.
Maintain strictest confidentiality based on HIPAA privacy policy.
Maintain current knowledge of coding guidelines and relevant federal regulations using current ICD-10 CM, CPT, HCPCS
Assure compliance by delivering quality services and meeting all contractual, state & federal legal and regulatory requirements.
Maintain CEU credits to ensure credentials are kept up to date.
Requirements:
Coding certification required through AHIMA or AAPC (at least one of the below):
Certified Professional Coder (CPC)
Certified Risk Adjustment Coder (CRC)
Certified Coding Specialist for Providers (CCS-P)
Registered Health Information Management Technician (RHIT)
5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred.
Prior experience with delivery of educational program content to include ICD-10-CM outpatient and CPT coding principals. Subject matter expertise and public speaking to a large audience, group level and 1:1 setting.
Prior experiences teaching/training others on correct coding guidelines and have the ability to present to large groups of Physicians/Providers .
Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines.
Excellent understanding of medical terminology, disease process, anatomy, and physiology.
Working Knowledge of CMS Risk Adjustment and HCC Coding Process.
Strong computer skills (i.e., MS Word, Excel, PowerPoint).
Ability to drive within assigned areas or overnight travel for internal or external meetings.
Capacity to attend provider meetings day/evening/weekends as needed within assigned areas. These meetings will primarily be in person with occasional virtual as defined by manager/leadership.
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.
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, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
