Quality Review and Audit Analyst

The Cigna Group

. Conduct medical record reviews and accurately abstract diagnosis codes according to Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols, and applicable rules .

Posted 10/2/2026full-timeRemote • Tennessee • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in ICD-10-CM coding guidelines and HCC coding, with a strong focus on compliance and risk adjustment processes. Proficient in conducting medical record reviews, audits, and collaborating with stakeholders to ensure accurate coding and documentation.

Highest-signal resume keywords

ICD-10-CM CodingHCC Coding ExperienceMedical Documentation AuditsCPC CertificationCMS Regulations Familiarity

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewDiagnosis CodingData AuditsRisk Adjustment Model ApplicationData Capture Identification

Soft Skills

Detail-OrientedSelf-MotivatedExcellent Organizational SkillsEffective Communication

Tools & Technologies

ExcelMS WordAdobe Acrobat

Certifications & Qualifications

CPCCCS-PCCS-HRHITRHIACRC

Industry Keywords

Risk Adjustment ProgramsCoding Compliance PoliciesHHS ProtocolsCigna IFP Coding GuidelinesRADV Audits

About the role

Key responsibilities & impact

Conduct medical record reviews and accurately abstract diagnosis codes according to Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols, and applicable rules
Use the HHS Risk Adjustment Model to confirm HCC accuracy from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year
Apply longitudinal thinking to identify valid data elements and data-capture opportunities under HHS Risk Adjustment
Perform documentation and data audits to identify risk-adjustment data gaps, inaccuracies, and compliance risks
Support IFP Risk Adjustment programs, including RADV audits and the Supplement Diagnosis submission program
Conduct quality audits of vendor coding partners
Collaborate with team members and matrix partners on coding and Risk Adjustment education for internal and external partners
Coordinate with stakeholders to execute efficient and compliant Risk Adjustment programs
Escalate identified risks and program gaps to management in a timely manner
Develop and implement internal program processes supporting CMS/HHS-compliant programs
Contribute to Cigna IFP Coding Guideline updates and policy determinations as needed

Requirements

What you’ll need

High school diploma
Prefer 2 years’ experience in one of the listed AHIMA or AAPC coding certifications
Certification such as CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC
Individuals with a certification other than CRC must become CRC certified within 6 months of hire
Experience with medical documentation audits and medical chart reviews
Proficiency with ICD-10-CM coding guidelines and conventions
Familiarity with CMS regulations for Risk Adjustment programs and documentation and coding compliance policies, covering inpatient and outpatient documentation
HCC coding experience preferred
Computer competency with Excel, MS Word, and Adobe Acrobat
Detail-oriented, self-motivated, and excellent organizational skills
Understanding of medical claims submissions preferred
Ability to meet timeline, productivity, and accuracy standards
Ability to communicate effectively across all audiences, verbally and in writing
For home working, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload

Benefits

Comp & perks

Remote work option (working at home occasionally or permanently)
Internet service requirement for home working: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload
Tobacco-free policy; qualifying smoking cessation program may be available where legally permissible
Equal employment opportunity and reasonable accommodation support