Lead Quality Review and Compliance Analyst
2 weeks ago
Job Overview
This temporary position is facilitated through PRO Unlimited with a prominent health insurance provider.
Quality Review & Audit Senior Representative
Department: Chart Administration & Interoperability
Position Summary:
The Quality Review & Audit Senior Representative plays a vital role in supporting Cigna's Individual and Family Plans (IFP) Risk Adjustment Chart Administration initiative, working under the guidance of management to ensure efficient chart retrieval, processing, and administrative functions.
Key Responsibilities:
- Oversees all chart retrieval operations for IFP projects, executing tasks as outlined by departmental workflows, including tracking pending records, assessing chart availability, verifying completeness and image quality, directing charts to the correct locations, troubleshooting with retrieval vendors, and documenting activities in the specified application.
- Conducts outreach via telephone or secure fax to healthcare provider offices for requests, which may include additional information requirements, record delivery, addressing deficiencies in retrieved records, and completing signature deficiency attestations as necessary.
- Safeguards the confidentiality and security of Cigna customer PPI/PHI by adhering to all HIPAA regulations, compliance standards, and Cigna's information release protocols.
- Adheres to Cigna's medical records policies regarding storage and retention.
- Maintains a daily production log in a specified format, submitting it to the Supervisor on a weekly basis.
- Engages in chart processing, vendor resolution, provider research, and other necessary tasks to effectively implement IFP Risk Adjustment programs.
- Exhibits clear, concise, and professional communication with colleagues and supervisors, both verbally and in writing.
Essential 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 as part of a team and work independently on time-sensitive assignments.
- 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 preferred; training will be provided.
- Must present a professional appearance, possess strong oral and written communication skills, and demonstrate self-direction and organizational skills.
- Previous experience with medical records is advantageous.
- Experience with EMR/EHR systems is preferred but not mandatory.
- Familiarity with HCC coding is a plus but not required.
Preferred Skills:
- Knowledge of medical records and basic medical terminology.
- Basic proficiency in Microsoft Excel, Outlook, Adobe, and Word.
- Ability to work collaboratively and independently on time-sensitive projects.
- Detail-oriented with strong multitasking abilities, accuracy in data entry, and the capacity to follow directions and apply criteria across various measures.
Work Arrangement:
- Hybrid work model.
Compensation:
- The hourly pay rate for this position will be determined based on location, experience, and expectations.
Benefits:
Medical, Dental, Vision, 401K (subject to minimum eligibility hours).
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