Medicare Quality Coding Review and Audit Manager- Hybrid- Healthcare- CT, PA, TN, TX, or MO

2 months ago

Nashville, Tennessee, United States Cigna Full time
Job Summary:

The Medicare Coding Quality Review Audit Manager is responsible for day-to-day oversight of the Risk Adjustment coding quality assurance operations for the Cigna Medicare segment. This role receives support from the MDQO and RADV leadership teams, Compliance and Legal teams, and other matrix partners.

Core Responsibilities:

  • End-to-end management of multiple cross-functional and focused risk adjustment coding initiatives that vary widely in scope and often have conflicting timelines.
  • Develops and maintains work plans that consider the priorities, key milestones, time and cost estimates, resource requirements, task sequencing, and identification of tasks that may be performed concurrently to achieve objectives.
  • Leads team of certified coders and administrative support personnel to ensure that coding compliance related risk adjustment coding initiatives are completed in compliant fashion and within mandated timelines.
  • Leads a team of 3 Supervisors, who have teams of certified professional coders conducting QA audits. Responsible for hiring, counseling, and developing team members, as needed, to ensure that Cigna's pipeline of talent is broadened.
  • Plans, develops, implements, and monitors Cigna's Medicare's QA of coding projects.
  • Monitors key performance indicators and works collaboratively with leadership to report on influencing factors and evaluating trends on internal coder and external coding vendor performance and optimization progress
  • Analyzes and measures the effectiveness of existing risk adjustment coding initiatives and collaborates with matrix partners to lead and develop a sustainable, repeatable and quantifiable process for growth.
  • Oversees any vendor-based coding initiatives to ensure that day-to-day solutions are performed as designed
  • Works closely with Quality Review Audit Advisor to ensure Risk Adjustment coding activities performed by their team adhere to Cigna's Coding Best Practices and CMS regulations
  • Provides ongoing and timely updates on risk adjustment coding activities to MDQO leadership, tailoring messages, as needed, for targeted stakeholder audience.
  • Works closely with RADV and MDQO leadership teams to establish metrics for critical coding activities and provide updates to segment leadership on a regular basis
  • Ensures that risk adjustment coding projects are completed within the established timeframes and are integrated with other business and related projects

Minimum Qualifications:

  • Bachelor's degree or equivalent relevant work experience; at least 5 years of coding experience, and certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) in one of the following certifications, is strongly preferred:
    • Certified Professional Coder (CPC)
    • Certified Coding Specialist for Providers (CCS-P)
    • Certified Coding Specialist for Hospitals (CCS-H)
    • Registered Health Information Technician (RHIT)
    • Registered Health Information Administrator (RHIA)
    • Certified Risk Adjustment Coder (CRC) certification
  • Knowledge of CMS RADV audits and approaches and 2 years + of RADV coding experience is highly preferred
  • Familiarity with Medicare Risk Adjustment is highly preferred
  • Previous supervisory experience is required, minimum of 2 years in role.
  • Requires strong analytical and organizational skills
  • Demonstrates ability to deal with ambiguity and to turn plans into actions
  • Demonstrates the ability to take initiative and act with urgency and integrity, as needed.
  • Demonstrates strong leadership skills in order to motivate, mentor, and inspire team members.
  • Exceptional communication skills, including written and verbal (formal and informal)
  • Demonstrated change agent skills within a matrix environment
  • Demonstrates medium proficiency in Microsoft Office skills related to Excel , PowerPoint and Word

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: for support. Do not email 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.

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