United States onlySummary:
The Quality Auditor performs internal audits for E/M Coding and validates Scoring Tool’s accuracy. The auditor records and reports result, identifies issues, trends and opportunities. Champion’s quality outcomes and purposeful well thought out change.
Duties and Responsibilities:
E/M Scoring Tools - review, verify, & validate E/M Scoring tools. Detect issues, propose improvements, and guarantee tool accuracy.
Monitor tools performance in production environments.
Collaborate with cross-functional teams to address audit findings.
Evaluates Tools for regulatory and ethical compliance.
In depth audit of E/M Edit claim reviews.
Other Business Unit quality or focus audits if needed.
Review and validate correct process and savings was followed and documented.
Communicates audit result with end users in a professional manner.
Record audit results and identify trends.
Recommend process improvements.
Functions as a Subject Matter Expert to matrix partners.
Audit reviews for policy and compliance accuracy.
Performs other appropriate duties as assigned to meet the needs of the department.
Must act as a change agent fostering independent thinking, staff motivation/direction, and the delivery of a quality product in a rapidly changing environment.
Qualifications
- Associate's Degree or higher strongly preferred or equivalent work experience required.
- 3+ years of medical coding experience required.
- One or more certifications required: Certified Coding Specialist (CCS), or Certified Profession Coder (CPC) (AAPC accredited preferred) or Certified Evaluation and Management Coder (CEMC).
- Experience in Quality Auditing a plus.
- Professional E&M Coding experience for professional billing and/or facility billing is required.
- Strong understanding of physiology, medical terms and anatomy
- Proficiency in using digital tools, such as coding software and patient record platforms.
- Payment integrity and claim review experience a plus.
- Knowledge of the Principles of Health Care Reimbursement.
- Experience in coding across multiple practices and remote coding experience is a plus.
- Extensive knowledge of Complex Claim Units processing standards, policies and SOPs.
- Must be able to gather, interpret, produce, and communicate progress, opportunities, and outcomes in both written and oral presentations.
- To excel in this role applicant should demonstrate great attention to detail.
- Excellent leadership skills.
- Knowledge of national trends, state and federal mandates, and compliance standards.
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 annual salary of 67,200 - 112,000 USD / yearly, 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 The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [email protected] for support. Do not email [email protected] 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.
