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Quality Control and Audit Senior Associate

2 months ago

Nashville, Tennessee, United States Cigna Full time

Job Overview

This is a temporary position facilitated through PRO Unlimited for one of the foremost health insurance providers globally.

Position Title: Quality Review & Audit Senior Representative

Department: Chart Administration & Interoperability

Role Summary:

The Quality Review & Audit Senior Representative plays a crucial role in supporting Cigna's Individual and Family Plans (IFP) Risk Adjustment Chart Administration initiative. This position involves daily chart retrieval, processing, and administrative responsibilities under the guidance of management.


Key Responsibilities:

  • Oversees all chart retrieval processes for IFP projects, executing actions as outlined by departmental workflows. This includes tracking outstanding records, assessing chart availability, ensuring completeness and image quality, directing charts to the correct locations, collaborating with retrieval vendors, and documenting activities in the specified application.
  • Conducts outreach via telephone or secure fax to healthcare provider offices for various requests, including additional information, record delivery, addressing deficiencies in retrieved records, and completing signature deficiency attestations as necessary.
  • Upholds the confidentiality and security of Cigna customer PPI/PHI by adhering to all HIPAA regulations, compliance requirements, and Cigna's information release protocols.
  • Adheres to Cigna's medical records policies regarding storage and retention.
  • Maintains a daily production log in a designated format, submitting it to the Supervisor on a weekly basis.
  • Engages in chart processing, vendor pend resolution, provider research, and other tasks essential for executing IFP Risk Adjustment programs.
  • Exhibits clear, concise, and professional communication with colleagues and supervisors, both verbally and in writing.

Required Qualifications:

  • High School Diploma or equivalent.
  • Familiarity with medical records, including basic medical terminology.
  • Basic proficiency in Microsoft Excel, Outlook, Adobe, and Word.
  • Ability to collaborate effectively in a team setting and independently on time-sensitive tasks.
  • Detail-oriented, capable of multitasking, accurate in data entry, able to follow instructions, and apply criteria across multiple measures.
  • Proficient in using standard office equipment (e.g., fax machines, photocopiers, printers).
  • A general understanding of healthcare privacy regulations is advantageous; training will be provided.
  • Candidates should present a professional demeanor, possess strong oral and written communication skills, and be self-motivated and organized.
  • Prior experience with medical records is preferred.
  • Experience with EMR/EHR systems is beneficial but not mandatory.
  • Familiarity with HCC coding is a plus but not required.

Essential Skills:

  • Knowledge of medical records and basic medical terminology.
  • Proficiency in Microsoft Excel, Outlook, Adobe, and Word.
  • Ability to work collaboratively and independently on time-sensitive projects.
  • Detail-oriented, capable of multitasking, and accurate in data entry while following instructions and applying criteria for various measures.

Work Arrangement:

  • Hybrid

Compensation:

  • The hourly pay rate for this position is dependent on location, experience, and expectations.

Benefits:
Medical, Dental, Vision, 401K (subject to minimum eligibility hours being met)