Risk Adjustment Coding Specialist

4 weeks ago

Chattanooga, Tennessee, United States The Cigna Group Full time
Job Summary

This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational market. The role will be accountable for assigned provider groups reaching risk adjustment related annual metrics.

Key Responsibilities
  • Support the training and development of Senior Analysts and Lead Representatives.
  • Identify and influence adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups.
  • Complete and accurate review of multi-year diagnosis coding of assigned population.
  • Understand, develop, track, monitor, and report on key program performance metrics for coding initiatives.
  • Work closely with matrix partners to ensure provider office communications are effective and efficient.
  • Analyze data regarding trends or patterns identified in provider office diagnosis coding.
  • Implement provider office education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards.
  • 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.
  • Conduct chart reviews for providers and review provider performance.
  • Assist with research, analysis, and response to inquiries from all internal and external audit departments regarding compliance, coding, and inappropriate coding.
  • Provide 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.
Requirements
  • Coding certification required through AHIMA or AAPC.
  • 5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred.
  • Strong public speaker with excellent written and verbal communication skills and experience effectively delivering subject matter expertise to a large audience.
  • 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 CPT/Evaluation and Management guidelines.
  • 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.
About The Cigna Group

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 healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.

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.

  • Risk Adjustment Medical Coder

    4 weeks ago

    Chattanooga, Tennessee, United States BlueCross BlueShield of Tennessee Full time

    Job SummaryWe are seeking a skilled Risk Adjustment Medical Record Coder to join our team at BlueCross BlueShield of Tennessee. As a key member of our Senior Care division, you will be responsible for performing first-pass reviews of medical records and physician assessment forms to capture risk-eligible conditions for Medicare Advantage and Affordable Care...

  • Medical Coding Specialist

    4 weeks ago

    Chattanooga, Tennessee, United States Catholic Health Initiatives Full time

    About the RoleWe are seeking a skilled Medical Coding Specialist to join our team at Catholic Health Initiatives. As a key member of our coding team, you will be responsible for accurately assigning codes to patient records, ensuring compliance with regulatory standards, and collaborating with healthcare professionals to improve coding quality and...

  • Provider Education Lead Analyst

    3 weeks ago

    Chattanooga, Tennessee, United States Cigna Full time

    Job SummaryThis role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational market. The role will be accountable for assigned provider groups reaching risk adjustment related annual metrics. This role will work directly with providers to assist in achieving accurate and complete coding...

  • Portfolio Management Risk Specialist

    1 week ago

    Chattanooga, Tennessee, United States Capital One Financial Corp Full time

    Job Title: Portfolio Management Risk SpecialistCapital One Financial Corp is seeking a highly skilled Portfolio Management Risk Specialist to join our team. As a key member of our Anti-Money Laundering (AML) - Models and Advanced Data Insights (MADI) organization, you will play a critical role in building and leading portfolio management / product operations...

  • Vulnerability Researcher

    4 weeks ago

    Chattanooga, Tennessee, United States Kyrus Tech Full time

    About the RoleKyrus Tech is seeking a skilled Vulnerability Researcher to join our team. As a key member of our team, you will play a critical role in identifying vulnerabilities through reverse engineering of compiled code and developing solutions to mitigate these risks.ResponsibilitiesReverse engineer compiled code using IDA Pro, Ghidra, and radare2 to...

  • Risk Evaluation Specialist

    4 weeks ago

    Chattanooga, Tennessee, United States Unum Group Full time

    Job SummaryWe are seeking a highly skilled Underwriting Consultant to join our team at Unum Group. As a key member of our underwriting team, you will be responsible for evaluating and selecting risk to ensure the profitable acquisition of new cases and the continued profitable retention of in force cases.Key ResponsibilitiesConsult with sales and service...

  • Risk Evaluation Specialist

    4 weeks ago

    Chattanooga, Tennessee, United States Unum Group Full time

    Underwriting ConsultantAt Unum Group, we're committed to helping our customers thrive. As an Underwriting Consultant, you'll play a critical role in ensuring the profitable acquisition and retention of business within assigned authority limits.Key Responsibilities:Partner with sales and service teams to provide tailored solutions that meet customer...

  • Coding Auditor

    4 weeks ago

    Chattanooga, Tennessee, United States BlueCross BlueShield of Tennessee Full time

    Job SummaryWe are seeking a skilled Coding Auditor to join our team at BlueCross BlueShield of Tennessee. As a Coding Auditor, you will play a critical role in reviewing claims and medical records to ensure accuracy and compliance with regulatory requirements.Key ResponsibilitiesConduct thorough reviews of claims and medical records to identify potential...

  • Insurance Claims Specialist

    2 weeks ago

    Chattanooga, Tennessee, United States Medical Personnel Services Full time

    Job Title: Insurance Follow-Up SpecialistAt Medical Personnel Services, we are seeking a highly skilled Insurance Follow-Up Specialist to join our team. As a key member of our accounts receivable team, you will be responsible for ensuring timely and accurate payment from third-party payers.Key Responsibilities:Resubmit primary, secondary, and tertiary claims...

  • Bilingual Community Specialist

    2 weeks ago

    Chattanooga, Tennessee, United States Youth Villages Full time

    Job Title: Bilingual Community SpecialistWe are seeking a highly motivated and compassionate Bilingual Community Specialist to join our team at Youth Villages. As a Community Specialist, you will work with at-risk youth and families in a community-based setting, providing counseling and support services to help them achieve their...

  • Safety and Risk Management Specialist

    2 weeks ago

    Chattanooga, Tennessee, United States Lee Company Full time

    Safety and Risk Coordinator RoleThe Safety Coordinator is responsible for developing and implementing organizational safety programs to ensure a safe and healthy work environment across construction and general industry settings.This role focuses on building strong relationships with employees and managers to promote a culture of safety and ensure compliance...

  • LifeSet Specialist

    3 weeks ago

    Chattanooga, Tennessee, United States Youth Villages Full time

    About Youth VillagesYouth Villages is a nonprofit organization dedicated to helping troubled youth and families achieve success. With a team of 4,500 individuals across 26 states, we provide counseling and treatment services to youth with severe emotional and behavioral problems.Job SummaryWe are seeking a PRN LifeSet Specialist to join our team. As a...

  • Compliance Auditor

    4 weeks ago

    Chattanooga, Tennessee, United States Erlanger Health System Full time

    Compliance Auditor - MonitorAt Erlanger Health System, we are seeking a highly skilled Compliance Auditor - Monitor to join our team. As a Compliance Auditor - Monitor, you will be responsible for ensuring that our hospital's operations are in compliance with relevant laws, regulations, and standards.Key Responsibilities:Conduct regular audits to identify...

  • Security Risk Manager

    1 week ago

    Chattanooga, Tennessee, United States FedEx Full time

    FedEx Security Specialist Job DescriptionAs a Security Specialist at FedEx, you will play a critical role in maintaining the safety and security of our employees, customers, and facilities. Your primary responsibilities will include:Key Responsibilities:Preventing and responding to threats to the safety and security of the FedEx systemMaintaining the...

  • Payment Application Specialist

    3 weeks ago

    Chattanooga, Tennessee, United States CORT FURNITURE RENTAL Full time

    Job Description OverviewCORT Furniture Rental is seeking a highly skilled Payment Application Specialist to join our National Billing & Collection Center.The primary responsibility of this position is to accurately post payments and adjustments to client accounts, including checks, money orders, lockbox suspense clearing entries, credit cards, wires, and...

  • Security Risk Manager

    2 weeks ago

    Chattanooga, Tennessee, United States FedEx Full time

    FedEx Security Specialist Job DescriptionAs a Security Specialist at FedEx, you will play a critical role in maintaining the safety and security of our employees, customers, and facilities. Your primary responsibilities will include:Key Responsibilities:Preventing and analyzing threats to the safety and security of the FedEx systemResponding to and resolving...

  • LifeSet Specialist

    2 weeks ago

    Chattanooga, Tennessee, United States Youth Villages Full time

    OverviewYouth Villages is a nonprofit organization dedicated to providing counseling and treatment services to at-risk youth and families. Our mission is to help troubled youth and families live successfully, and we're seeking a skilled LifeSet Specialist to join our team.ResponsibilitiesProvide in-home counseling services to at-risk youth and familiesManage...

  • LifeSet Specialist

    2 days ago

    Chattanooga, Tennessee, United States Youth Villages Full time

    OverviewYouth Villages is a nonprofit organization dedicated to providing counseling and treatment services to at-risk youth and families. Our mission is to help troubled youth and families live successfully, and we're seeking a skilled LifeSet Specialist to join our team.ResponsibilitiesProvide in-home counseling services to at-risk youth and familiesManage...

  • Plumbing Specialist

    3 weeks ago

    Chattanooga, Tennessee, United States Tradesmen International Full time

    Job Title: Plumbing SpecialistTradesmen International is seeking experienced Plumbing Specialists to join our team. As a Plumbing Specialist, you will be responsible for installing, maintaining, and repairing plumbing systems, including pipes, fixtures, and appliances.Key Responsibilities:Install and maintain plumbing systems, including pipes, fixtures, and...

  • Facility Relocation Specialist

    1 week ago

    Chattanooga, Tennessee, United States Catholic Health Initiatives Full time

    Job SummaryCatholic Health Initiatives is seeking a highly skilled Facility Movement Coordinator to join our team. As a key member of our facilities management team, you will be responsible for the installation, movement, setup, and adjustments of hospital equipment and assets.ResponsibilitiesAssist in the installation, movement, setup, and adjustments of...