Quality Review and Audit Lead Analyst

6 days ago

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Description

• Performs in-depth review of medical records to ensure accurate DRG coding • Reviews clinical documentation and validates facility coding for APR and MS DRG assignment • Communicates with Medical Directors for clinical validation • Summarizes DRG disputes in writing and cites coding guidelines

Requirements

• Bachelor’s Degree or higher strongly preferred or equivalent work experience • Certified Coding Certificate - experience in DRG coding using ICD-10 coding system - 3+ years required • Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) required • RN License preferred but not required • Knowledge of CMS regulations and statutes • Knowledge of state/regional insurance regulations • Ability to handle sensitive information and adhere to HIPAA confidentiality procedures • Knowledge of Inpatient coding guidelines and practices • Effective written and verbal communication skills with Microsoft Office • Ability to work independently and in a team; attention to detail • Highly motivated with excellent prioritization skills

Benefits

• Comprehensive health-related benefits including medical, vision, dental • Well-being and behavioral health programs • 401(k) with company match • Company paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays