Job Information

Remote, work at home, United States

Responsible for Part C audit activities for the Cigna-HealthSpring (CHS) Compliance Department, with particular emphasis on Coding, Risk Adjustment and Coding Decisions. Collaborates with CHS Compliance colleagues and business partners to drive process improvements, monitor and audit ICD-10 codes submitted to CHS by providers, identify codes that may be submitted inappropriately and where identified ensure effective corrective action. S/he forges and maintains positive working relationships with business owners, management, regulators and compliance colleagues and demonstrates the ability to influence business partner and/or staff behavior at whatever level and to whatever extent is needed.

To be successful, this candidate must exhibit superior analytical, coding skills (including ICD-9 and ICD-10), strong knowledge of HCC's and risk scores, communication and collaborative skills, as well as the ability to excel in a dynamic, fast-paced environment. The candidate must demonstrate solid command of risk adjustment. This compliance team member must be adept at working with a variety of internal and external stakeholders. S/he will promote an enterprise-wide culture of compliance and provide first-rate support within the Compliance Department and across the business units.

  • Reports to the Part C Compliance Manager;
  • Monitors transactions and business processes associated with reconciling ICD-9/ICD-10 codes received from providers with the provider's medical records as well as establishing the appropriate use of codes received;
  • Provides subject matter expertise in response to day-to-day business issues related to coding and risk adjustment;
  • Manage a specific caseload of risk adjustment projects as assigned, from start to finish, in a timely manner;
  • Monitor transactions related to the risk adjustment process and coding (ICD-9/ICD-10) either onsite, via webinar or by means of a desk review. Monitoring risk adjustment transactions include, amongst others, validating universes, preparing and/or executing programs to monitor and monitoring targeted transactions by way of walk-throughs, conducting interviews, and performing tests/reviews;
  • Stay abreast of industry changes and/or trends including but not limited to Federal Risk Adjustment cases;
  • Researches guidelines to ensure C-HS coding best practices remain consistent with CMS RADV Coding Guidance and ICD-10 coding guidelines;
  • Collaborates with all areas of compliance, the special investigations unit, and business owners to drive process improvements and ensure that corrective action plans are tailored and appropriate for the deficiencies identified; and
  • Provide meaningful and appropriate reporting to support compliance audit.

Bachelor's degree or equivalent
5+ years of experience with Medicare Risk Adjustment
5+ years of experience working with Medicare Advantage, Medicare-Medicaid Plan (Dual-Eligible) and/or Medicaid a must
5+ years of experience with auditing needed
Experience with Risk Adjustment Data Validation Audits required
Strong knowledge of Medicare Risk Adjustment regulations required
Strong knowledge of Risk Adjustment and Hierarchical Condition Category (HCC) coding
payment model (i.e., v12 and v22) required
Certified Coding Specialist (CCS) required

For this position, we anticipate offering an annual salary of $82,400 - $137,300, depending on relevant factors, including experience and geographic location.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we'll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and best in class 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 dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the "Life at Cigna" tab on our careersite:

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.


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