• Job Description

  Req#: 23019681

  Job Summary:

  This role is responsible for supporting Cigna Medicare Advantage’s Risk Adjustment & Stars program for assigned populations in an operational market. This role will have responsibility for report distribution to external partners and associated follow up for market population. Senior Representatives will support local market efforts to collect medical records for all audits and HEDIS medical record reviews. The role will work under the direction of Risk Adjustment & Stars Provider Education Supervisor and/or Manager to reach overall operational market goals in conjunction with market network operations, stars strategy and vendor partners.

  Core Responsibilities:

  • Understands, tracks, monitors and distributes reports as defined to external and internal partners on key program performance metrics for risk adjustment and Stars initiatives.
  • Work closely with matrix partners including Network Operations, Stars or Clinical Operations, and vendors to ensure provider office communications are effective and efficient.
  • Understand report content and ability to explain report content and “ask” as result of report
  • Perform complete and accurate report distribution of coding related reports (form completion, form errors, chronic condition, potential conditions, Stars gaps in care, and others as defined by Supervisor) consistent with established departmental productivity goals to both internal and external partners.
  • Collect Medical Records from provider offices via EMR access, secure messaging, fax, or other approved methods for assigned sub-regions or markets for annual Comprehensive Medical Chart Reviews, audit requests, or other programs as directed.
  • Address barriers to medical record collection identified by third party vendors and make multiple, best efforts to resolve; when unable, escalate to Supervisor and appropriate teams for final attempts.
  • Demonstrate skills in accuracy and multitasking while working to impact progress within the daily workload requirements.
  • Monitors and addresses questions and action items sent to global mailbox for provider education.
  • Perform all tasks consistent with established departmental timelines and deadlines.
  • Maintain strictest confidentiality based on HIPAA privacy policy
  • Assure compliance by delivering quality and accurate services and meeting all Cigna contractual, state & federal legal and regulatory requirements.
  • Accountability to support coding provider education team with other administrative tasks.
  • Demonstrate a strong attention to detail.
  • Additional duties and responsibilities as assigned

  Minimum Requirements:

  • Coding certification preferred but not required (CRC, CCS-P, CPC or similar certification)
  • Medical Records experience preferred but not required
  • High School Diploma or higher
  • Strong computer skills with proficiency in Microsoft Office Suite required (i.e. Word, Excel, PowerPoint, Outlook)
  • Strong verbal and written communication skills
  • Familiar with SharePoint as role supports updates, data entry, etc.
  • Experience in provider office or similar setting with data review and report management/distribution
  • Ability to pivot and align to changes related to business needs
  • Ability to work effectively in a fast-paced, results-oriented environment while demonstrating professionalism at all times
  • Full time, work from home with preference to assigned geographic region

  
  

  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 hourly rate of 21 - 32 USD / hourly, depending on relevant factors, including experience and geographic location.

  This role is also anticipated to be eligible to participate in an annual bonus plan.

  We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

  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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

  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.

• About the company

  Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.

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