Quality Review and Audit Senior Analyst – RADV Job Summary: Responsible for coordination and implementation of daily processes related to IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis program. Responsible for liaising with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes, including but not limited to file reconciliation and appeals processes. Responsible for coordinating with Quality Mgmt to effectively and compliantly execute daily RA program operations, as identified. Participates in coding reviews of medical documentation for RA programs, as needed. Responsible for communication and reporting of daily productivity and risks associated with IFP RADV audits and other RA programs, as needed, and collaborates with internal educational team to develop necessary curriculum to ensure compliance and program excellence. Contributes to Cigna IFP Coding Guideline updates and policy determinations, and liaises with Matrix Partners, as required, to develop and promote shared goals. The Quality Review and Audit Senior Analyst position recognizes experience in Risk Adjustment Data Validation audits (RADV), Risk Adjustment operations, Risk Adjustment medical record and diagnosis coding excellence, implementation of Quality Improvement processes, and the ability to communicate experience and knowledge to peers, colleagues, and Matrix Partners. Core Responsibilities: - Oversight and coordination of daily operations for IFP Risk Adjustment Data Validation (RADV) audits, - Support of Supplemental Diagnosis programs, as required - Demonstrates comprehensive understanding and proficiency with the Complete Official Code Set, Coding Clinic, and CMS guidelines for IFP code abstraction and medical record compliance - Demonstrates comprehensive understanding of RADV Protocols and Compliance Requirements for RA programs, including EDGE Server Business Rules, where applicable - Demonstrates ability to coordinate with external partners to execute efficient and compliant programs - Demonstrates ability to identify risks or program gaps and communicate effectively to management in a timely manner - Demonstrates ability to report productivity, progress, and risks to leadership on a timely basis - Develops and implements internal program processes, as required - Coordinates with Quality Mgmt to determine priorities and demonstrates ability to prioritize projects to meet deadlines, as determined - Demonstrates the ability to remain current on Federal regulations related to diagnosis coding and the HHS Risk Adjustment program, including audit protocols - Demonstrates effective communication skills with peers and matrix partners to ensure Continuous Quality Improvement and ensure compliance with all CMS guidelines and regulations - Engages in Continuous Quality Improvement (CQI) of IFP programs, as applicable - Demonstrates ability to work with external auditors to ensure compliant, efficient, and successful risk adjustment audits, per CMS standards - Demonstrates medium proficiency with Microsoft Outlook, Microsoft Excel, Microsoft Word - Demonstrates clear and concise professional communication with peers and supervisors, in verbal, telephonic, and written communication - Demonstrates knowledge of HIPAA guidelines and protection of PHI in physical and electronic environments - Demonstrates the ability to follow verbal and written directions accurately and timely - Demonstrates the ability to follow applicable policies and procedures - Ability to work independently to accomplish assigned work within the allocated time, meeting deadlines as appropriate - Demonstrates ability and willingness to assume other duties as requested, which may or have not be listed in the job description Minimum Qualifications: - High School Diploma - 5+ year’s Risk Adjustment experience, with certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) in one of the following certifications: - 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 (within 12 months of hire) - Experience with medical audits - Proficiency with ICD-10-CM coding and guidelines - Familiarity with CMS regulations and polices related to documentation and coding, both with Inpatient and Outpatient documentation - HCC coding experience preferred - Computer competency with excel, MS Word, Adobe Acrobat - Must be detail oriented, self-motivated, and have excellent organization skills - Risk Adjustment/CMS knowledge helpful - Understanding of medical claims submissions is helpful 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. For this position, we anticipate offering an annual salary of 58,400 - 97,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. 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.

• Partner with Portfolio Managers in credit and underwriting, performing analytical tasks as needed • Use critical thinking to identify and draft documentation • Responsible for regularly completing indicative credit information into Banking Systems with little to no errors • Responsible for preparing risk-rating scorecard and tickler event analysis and determining actions based on results working in collaboration with PM's • Responsible for developing risk models and advising PMs of unforeseen obstacles that may impede meeting client expectations • Identify and determine monitoring analysis activities required • Verify covenants and define updates needed on ticklers • Monitor covenant completion and track past due or out of compliance covenants and recommend appropriate course of action • Responsible for assessing covenant compliance reporting and identifying issues • Review covenant compliance certificates to understand performance and determine actions • Update financial covenants and calculations as needed • Run Probability of Default (PD) model with oversight • Responsible for understanding and evaluating completed spreads to determine necessary edits working in collaboration with the CCU team • Responsible for identifying and recommending preliminary portfolio management actions using Credit Service reporting and RADAR with some oversight • Prepares ALSR reports with oversight • Responsible for running risk and projection models with oversight assumptions provided • Responsible for completing underwriting process with limited oversight • Create and complete a CAM with little to no errors • Review and re-write renewals for deals of limited complexity • Responsible for portfolio analysis and the development for Portfolio Reviews in preparation for client meetings • Support Portfolio Managers and special projects • Takes appropriate remedial actions to resolve deficiencies and escalates questions/disputes to appropriate level when necessary. • May assist with training of new employees. • May work on special projects as assigned by management.

Department BSD CTD - User Services - Plan X About the Department The Center for Translational Data Science (CTDS) at the University of Chicago is a research center whose mission is to develop the discipline of translational data science to impactful problems in biology, medicine, healthcare, and the environment. We envision a world in which researchers have ready access to the data needed and the tools required to make data driven discoveries that increase our scientific knowledge and improve the quality of life. We architect ecosystems of large-scale commons of research data, computing resources, applications, tools, and services for the broader research community to use data at scale to pursue scientific inquiry and accelerate discovery. Learn more at https://gdc.cancer.gov/ , https://gen3.org/ , https://stats.gen3.org/ , and https://ctds.uchicago.edu/. Job Summary The job uses best practices and knowledge to develop new and existing systems. Solves problems and anticipates evolving business requirements to identify, design, and implement appropriate process improvements, systems alternatives, and/or enhancements to current systems. Using a deep understanding of the technological and scientific goals and methodologies within assigned data commons and cloud environments, the Senior Scientific Support Analyst serves as a primary contact and resource for end-users, clients, Center staff, and User Services team members-guiding, tracking, resolving, reporting on and analyzing inquiries and reports related to all aspects of user experience within a Translational Data Science research environment. The Sr.SSA develops strategies for educating users and clients, triages complex issues, plans and participates as an expert in conferences and meetings with clients, and collaborates on user management and issue resolution with the Center’s functional teams, senior personnel, and subject matter experts with an end goal of providing exceptional customer service and optimal user experiences. This at-will position is wholly or partially funded by contractual grant funding which is renewed under provisions set by the grantor of the contract. Employment will be contingent upon the continued receipt of these grant funds and satisfactory job performance. Responsibilities - Serve as primary contact on assigned data inquiries, resolving issues and tracking queries in an efficient and timely manner; keeps and monitors records of issues, reporting and analyzing trends. - Provide exceptionally competent email support to our clients and staff, along with demonstrating dedication to high quality customer service. - Perform problem analysis, evaluation, recreating, and resolution of client report problems. - Use a deep understanding of the data, scientific goals and methodology, and underlying biological and translational concepts in assigned data commons and cloud environments to provide user support in high profile and troubling cases. - Take full ownership of assigned cases, triaging them to the appropriate resources and guiding them through to achieve final resolution. - Coordinate on user management and issue resolution with functional teams, including, but not necessarily limited to, operations, development, design, bioinformatics, data science, project management, and information security. - Assist senior personnel and subject matter experts on escalated issues; coach other User Services team members on responding to and collaborating on issues. - Exercise and exemplify good judgment to prioritize and manage inquiries of diverse scope and complexity. - Identify gaps and assist in the development of client-facing training materials and documents and internal-facing documents like Standard Operating Procedures. - Develop strategy on how to educate users on the technology and manage recommendations for optimization by participating in regular meetings on user experience and product development; includes planning, leading, and/or participating as an expert on CTDS data commons in conferences, symposia, and meetings with clients. - Identify and analyze needs for ongoing improvement of business and quality processes. - Stay current on user needs, internal projects, and the broader biotech, open source, and translational data science communities. - Collaborate with internal and external stakeholders on research use cases and demonstrations of a platform; lead user education initiatives. - Has a deep understanding of business process analyses, needs assessments, and preliminary cost/benefit analyses. Solves complex problems relating to computer equipment capacity, limitations, and operation time. - Utilizes thorough understanding of business systems and industry requirements to translate business and user needs into system requirement specifications. - Recommends process improvements in existing applications and revises existing system logic difficulties as necessary. Designs, develops, and implements new applications, systems architecture, network systems, and applications infrastructures. - Communicates and presents on system enhancements and/or alternatives to colleagues in IT management. - Performs other related work as needed. Minimum Qualifications Education: Minimum requirements include a college or university degree in related field. Work Experience: Minimum requirements include knowledge and skills developed through 5-7 years of work experience in a related job discipline. Certifications: --- Preferred Qualifications Education: - Advanced degree in Biology, Bioinformatics, Computer Science, or a related technical area with high preference on PhD in Biology, Bioinformatics, Computer Science, or a related technical area. Experience: - 5+ years of experience in customer service or client relations. - Technical documentation and writing experience. - Experience in bioinformatics, biostatistics, or related field. - Experience working on research infrastructure. - Experience with both hardware and software IT projects. - Experience working independently and taking ownership of work with minimal supervision. Preferred Competencies - Strong technical skills, ability to pick up quickly on our unique systems and offerings. - Ability to speak to both technical users and business stakeholders and interact at all levels of an organization. - Superior verbal and written communication skills. - Strong relationship building skills. - Ability to handle sensitive matters with tact and discretion. - Ability to come into a team used to minimal supervision and oversight and ensure accountability for performance. - Ability to take ownership within purview for user needs and identifying appropriate venues for advocating for user needs. - Ability to independently identify when user experience and needs should be escalated. - Ability to train users and help onboard new team members. Working Conditions - Office environment Application Documents - Resume (required) - Cover Letter (preferred) When applying, the document(s) MUST be uploaded via the My Experience page, in the section titled Application Documents of the application. Job Family Information Technology Role Impact Individual Contributor Scheduled Weekly Hours 40 Drug Test Required No Health Screen Required No Motor Vehicle Record Inquiry Required No Pay Rate Type Salary​ FLSA Status Exempt​ Pay Range $90,000.00 - $130,000.00The included pay rate or range represents the University’s good faith estimate of the possible compensation offer for this role at the time of posting. Benefits Eligible YesThe University of Chicago offers a wide range of benefits programs and resources for eligible employees, including health, retirement, and paid time off. Information about the benefit offerings can be found in the Benefits Guidebook. Posting Statement The University of Chicago is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender, gender identity, or expression, national or ethnic origin, shared ancestry, age, status as an individual with a disability, military or veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination. Job seekers in need of a reasonable accommodation to complete the application process should call 773-702-5800 or submit a request via Applicant Inquiry Form. All offers of employment are contingent upon a background check that includes a review of conviction history. A conviction does not automatically preclude University employment. Rather, the University considers conviction information on a case-by-case basis and assesses the nature of the offense, the circumstances surrounding it, the proximity in time of the conviction, and its relevance to the position. The University of Chicago's Annual Security & Fire Safety Report (Report) provides information about University offices and programs that provide safety support, crime and fire statistics, emergency response and communications plans, and other policies and information. The Report can be accessed online at: http://securityreport.uchicago.edu. Paper copies of the Report are available, upon request, from the University of Chicago Police Department, 850 E. 61st Street, Chicago, IL 60637.

• Responsible for developing & supporting management reporting, budgeting, forecasting and analysis for the Operations organization • Specific duties include daily reporting, compilation of the annual budget, monthly & quarterly forecasts • Measurement and presentation of key performance indicators relative to goals, targets, budgets, and trends • Prepare and lead presentations for senior leadership.