Quality Review and Audit Analyst

AnalystAnalystFull TimeRemoteMid LevelTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

$58.4K - $97.4K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Quality Review and Audit Analyst

The Cigna Group

Role Description The Quality Review & Audit Senior Analyst (“Analyst”) exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in support of the HHS’ Risk Adjustment (RA) program and Risk Adjustment Data Validation (RADV) audits. The Senior Analyst is responsible for all aspects of auditing medical documentation for diagnostic code abstraction, and possesses HHS’ Hierarchical Condition Category (HCC) expertise, evaluating data accuracy and record compliance, executing on audit requirements, and identifying and recommending process improvements within the RA program. - Proficient in assigning accurate ICD-10 diagnosis codes in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines, and HHS’ RADV Protocols. - Audits accuracy of abstracted diagnostic codes from identified medical record cohorts, evaluating work of peers and/or coding vendor coders, to ensure compliance with quality standards, scoring as appropriate per monthly quality feedback reports or other scoring instrument, as defined per policy. - Performs claims matching and auditing, as required, identifying missing or inaccurate data within RA claims and ensuring compliance with HHS’ RA program protocols. - Leads, trains, or mentors junior team members, as required, sharing expertise in RA programs. - Contributes to execution of Risk Adjustment programs, and other IFP programs, as needed, to ensure accurate and compliant data submissions. - Collaborates and coordinates with stakeholders to facilitate coding and risk adjustment education. - Contributes expertise to creation and maintenance of Coding Guidelines and Best Practices, as needed. - Participates in RADV execution for designated markets, including but not limited to, medical records reviews; subordinate, peer, or vendor coding audits; evaluation and reporting of progress, barriers, or errors; or other tasks as defined in HHS’ RADV Protocols. Qualifications - High School Diploma or equivalent; Bachelors or equivalent work experience preferred. - 5+ years’ experience in medical record coding, with certification in good standing from either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), in one or more of the following: - 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) - Willing to achieve CRC certification within 12 months of hire, if not previously certified. - Experience with Risk Adjustment coding and HCCs, demonstrating proficiency in ICD-10-CM medical diagnosis coding. - Familiarity with CMS regulations for Risk Adjustment programs helpful. - Medical claims, billing, or inpatient coding experience helpful. - Competency with MS Excel, MS Word, Adobe Acrobat, or other comparable software. - Must be detail oriented, self-motivated, and have excellent organization skills, with the ability to communicate professionally and effectively in all formats (verbal, written, electronic). - Ability to work independently, managing time to meet deadlines, timelines, productivity, and accuracy standards for program success. Requirements - 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. Benefits - Annual salary of 58,400 - 97,400 USD / yearly, depending on relevant factors, including experience and geographic location. - Eligibility to participate in an annual bonus plan. - Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment. - 401(k), company paid life insurance, tuition reimbursement. - A minimum of 18 days of paid time off per year and paid holidays.

Related Categories

Related Job Pages

More Analyst Jobs

Knock logo

Disclosure Analyst

Knock

The smarter, better way to buy your dream home. A 4x Inc. Best Workplace honoree! | NMLS #1958445

Analyst1 day ago
Full TimeRemoteTeam 11-50Since 2015H1B Sponsor

• Support the customer journey from application to funding • Provide an overview of Knock’s products and programs • Assist with seeing customers through to a successful closing • Gather required documentation to successfully submit the loan file for processing/underwriting and obtaining Initial Closing Disclosure signatures to meet on-time closings • Manage a pipeline consisting of 30 loan closings per month • Complete Patriot Act based on customer ID • Ensure minimum submission requirements and documents are met prior to submitting loans to processing • Assist team members with any borrower requests • Understanding of TRID to compliantly issue initial disclosures and revised Loan Estimates within 24-48 hours of receiving loan • Experience with condo approval requirements including requesting documents and reviewing documents to ensure all relevant questions are completed • Promote a culture that puts People First, with an emphasis on best-in-class customer service from lead to closing • Continually learn, grow, and expand your knowledge of the mortgage origination process • Take on ad-hoc projects as they arise

Arizona + 10 moreAll locations: Arizona | California | Colorado | Idaho | Montana | Nevada | New Mexico | Oregon | Utah | Washington | Wyoming
$53K / year
ContractRemoteTeam 1,001-5,000H1B No Sponsor

• Support the design, administration, and analysis of compensation programs including base pay, incentive plans, and job architecture. • Serve as a hands-on user of compensation technology platforms and AI-powered tools. • Support market pricing activities by utilizing external survey platforms and AI-driven benchmarking tools. • Partner in job leveling activities by evaluating roles using established frameworks and AI-assisted job matching outputs. • Administer quarterly incentive programs including data collection, validation, tracking, and payout processing. • Assist with compensation planning cycles (e.g., merit, promotions, and adjustments). • Provide support for equity administration including ESPP tracking, grant records, and basic employee inquiries. • Analyze compensation and equity data to identify trends, variances, and opportunities.

United States
$55 - $57 / hour
Airbnb logo

Senior Analyst, Advanced Analytics

Airbnb

Airbnb is a community based on connection and belonging.

Analyst1 day ago
Full TimeRemoteTeam 5,001-10,000Since 2007H1B Sponsor

• Data thought partner to product and business leaders, providing insights, recommendations, and enabling data-driven decisions. • Contribute towards advancing the Analytics and Data Science disciplines at Airbnb, including driving data best practices, building new data tools and data sets, expanding data education around the company and mentoring and developing other team members. • Drive day to day analytics and create scalable data tools: • Architect, build, and launch efficient & reliable new data models and pipelines in partnership with Data Engineering • Design, define, and implement metrics and dimensions to enable analysis • Continue to enhance our understanding and measurement of the tools used by our partners, with a focus on driving higher host activation within partner buildings. • Work closely with Data Engineers, Analytics Engineers, Data Scientists and other cross functional teams to build a scalable and unified attribution and measurement platform for understanding impact of product, sales and marketing efforts. • Collaborate closely with Business Leads to design, implement, and assess offline experiments, including A/B tests and other quasi-experimental techniques. • Empower the team to answer data questions quickly and easily by building high-quality ground truth data sets and dashboards. Collaborate with Data Engineering to build data tools for mass consumptions within the A4RE team

United States
$136K - $160K / year
UnityPoint Health logo

Reimbursement Analyst

UnityPoint Health

UnityPoint Health is a healthcare system whose coordinated approach to medical care serves patients across metropolitan and rural communities in Iowa and Illinois. Founded in 1995

Analyst1 day ago

Role Description UnityPoint Health is seeking a Reimbursement Analyst to join our team! If you have advanced Excel skills, an analytical background, and healthcare experience, we would love for you to apply! In this role, you would be responsible for: - Completion of annual cost reports - Coordination of third party audits - Assisting with calculation and analysis of third party contractual allowances - Monitoring compliance with third party payer regulatory changes - Consulting with management on governmental reimbursement programs for UnityPoint Health (UPH) affiliated providers and UPH Community Connect hospitals Hours: Monday-Friday, standard business hours Location: Remote - applicants preferably reside within the UPH footprint of Iowa, Illinois, or Wisconsin Qualifications - Required: Bachelor's degree in business, finance, or accounting - Required: Minimum of 3 years work experience in finance, accounting, or analytics - Preferred: Healthcare finance operations or reimbursement experience Requirements - Completes annual cost reports based on the data and information received from the facility financial systems, billing systems and management - Meets with facility management to ensure operational changes have been incorporated in the cost report and contested items are handled appropriately - Works closely with facility management to ensure reimbursement related issues are addressed consistently, timely and accurately - Coordinates providing information for third party audits of cost reports, works with auditors to resolve any outstanding issues and provide written response to audit adjustments when needed - Assists with the impact analysis of unique reimbursement methodologies applicable to both urban and rural providers as well as various provider types/designations and the filing of any letters requesting application or approval of these methodologies - Reviews new legislation and regulatory changes impacting the reimbursement aspects of the integrated services provided by the providers and provides consultation and expert advice to management with regard to the changing regulations - Performs contractual allowance calculations and analysis of the contractual variances to budget for the assigned facilities - Assists with the annual review of budgeted contractual expense - Assists with the review of third party liability schedules to ensure appropriate reserve levels are maintained - Reviews and makes recommendations regarding system reporting needs that effectively, efficiently and consistently provide the necessary data to support routine reimbursement functions - Acts as a liaison with management to provide support in communications to other stakeholders in their organizations (i.e. Board Committees, Dept. management) - Assists with obtaining information for reimbursement projects where outside consultants have been engaged, including Appeals - Performs other reimbursement related functions as requested Benefits - Paid time off, parental leave, 401K matching and an employee recognition program - Dental and health insurance, paid holidays, short and long-term disability and more - Pet insurance for your four-legged family members - Early access to earned wages with Daily Pay - Tuition reimbursement to help further your career - Adoption assistance to help you grow your family

United States