Medicare Quality Coding Review and Audit Manager- Hybrid- Cigna Healthcare- CT, PA, TN, TX, or MO

Job Summary :

The Medicare Coding Quality Review Audit Manager is responsible for day-to-day oversight of the Risk Adjustment coding quality assurance operations for the Cigna Medicare segment. This role receives support from the MDQO and RADV leadership teams, Compliance and Legal teams, and other matrix partners.

Core Responsibilities :

• End-to-end management of multiple cross-functional and focused risk adjustment coding initiatives that vary widely in scope and often have conflicting timelines.
• Develops and maintains work plans that consider the priorities, key milestones, time and cost estimates, resource requirements, task sequencing, and identification of tasks that may be performed concurrently to achieve objectives.
• Leads team of certified coders and administrative support personnel to ensure that coding compliance related risk adjustment coding initiatives are completed in compliant fashion and within mandated timelines.
• Leads a team of 3 Supervisors, who have teams of certified professional coders conducting QA audits.  Responsible for hiring, counseling, and developing team members, as needed, to ensure that Cigna's pipeline of talent is broadened.
• Plans, develops, implements, and monitors Cigna's Medicare's QA of coding projects.
• Monitors key performance indicators and works collaboratively with leadership to report on influencing factors and evaluating trends on internal coder and external coding vendor performance and optimization progress
• Analyzes and measures the effectiveness of existing risk adjustment coding initiatives and collaborates with matrix partners to lead and develop a sustainable, repeatable and quantifiable process for growth.
• Oversees  any vendor-based coding initiatives to ensure that day-to-day solutions are performed as designed
• Works closely with Quality Review Audit Advisor to ensure Risk Adjustment coding activities performed by their team adhere to Cigna’s Coding Best Practices and CMS regulations
• Provides ongoing and timely updates on risk adjustment coding activities to MDQO leadership, tailoring messages, as needed, for targeted stakeholder audience.
• Works closely with RADV and MDQO leadership teams to establish metrics for critical coding activities and provide updates to segment leadership on a regular basis
• Ensures that risk adjustment coding projects are completed within the established timeframes and are integrated with other business and related projects

Minimum Qualifications :

Certified Professional Coder (CPC)