Quality Review & Audit Senior Representative - Cigna Healthcare - Remote
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About this role
Supports Cigna’s Risk Adjustment program by performing Quality Assurance, audit, and medical record chart retrieval activities. Independently completes day‑to‑day quality reviews and audits with limited supervision, escalating non‑routine issues as needed. Identifies process improvement opportunities and assists with the development of audit guidelines.
This role focuses on auditing, troubleshooting, and resolving issues related to the retrieval, processing, and quality of medical records while ensuring compliance with HIPAA and Cigna policies.
Core Responsibilities
- Monitor and manage chart retrieval activities for IFP projects, including tracking outstanding records, identifying retrieval barriers, evaluating chart availability, and reviewing records for completeness and image quality.
- Route charts appropriately, document activities in designated systems, and resolve issues with retrieval vendors.
- Conduct outbound outreach to provider offices via phone or secure fax to request records, resolve deficiencies, and obtain required attestations.
- Perform daily quality audits of vendor submissions, provider responses, and related retrieval requirements.
- Ensure confidentiality and security of PPI/PHI and adhere to HIPAA, regulatory, and Cigna policies.
- Maintain production tracking and required reporting.
- Perform chart processing, vendor pend resolution, provider research, and other support tasks as needed.
Minimum Qualifications
- High School Diploma or equivalent.
- Knowledge of medical records and basic medical terminology.
- Basic proficiency with Microsoft Excel, Outlook, Word, and Adobe.
- Strong attention to detail, data accuracy, and ability to multitask.
- Ability to work independently and collaboratively on time‑sensitive work.
- Ability to identify issues requiring escalation.
- General understanding of healthcare privacy regulations.
- Clear, professional verbal and written communication skills.
- Prior experience with medical records and EMR/EHR systems preferred.
- Experience with HCC coding preferred but not required.
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.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.