Cigna Provider Services Analyst in Harlingen, Texas
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At least two years’ of hospital inpatient / outpatient or medical office coding experience, preferably two years risk adjustment coding experience. Coding certification, which may include Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), required.
Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines. Excellent understanding of medical terminology, disease process and anatomy and physiology. Working knowledge of CPT/Evaluation and Management guidelines, Working Knowledge of CMS Risk Adjustment and HCC Coding Process, Strong computer skills (i.e. MS Office). Prior audit/quality experience. Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers. Travel will be required for this position and person needs to be available for day and evening session and the ability to travel, both in and out of state, if needed.
• Conduct provider training on health plan coding initiatives
• Conduct chart reviews for providers and review provider performance. This is accomplished by traveling to the individual practices and performing side-by-side education
• Develop relationships with clinical providers/staff and communicate coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
• Evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures
• Query providers regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
• Analyze data to prioritize provider educational reviews. Implement education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards
• Assist, as needed, with HCC coding to meet departmental goals/deadlines
• Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data
• Assists with research, analysis and response to inquiries regarding compliance, coding, and inappropriate coding
• Compile data and present solutions regarding trends or patterns noticed in provider coding
• Perform the minimum number of coding quality reviews consistent with established departmental goals
• Take direction and guidance from Risk Adjustment Coding Lead and the General Manager of the Coding Department
• Maintain a 95% quality audit accuracy rate
• Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM book, and other pertinent materials
• Ability to drive within assigned areas
• Capacity to attend provider meetings day/evening/weekends as needed within assigned areas
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.
If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
We’re a global health service company dedicated to helping people improve their health, well-being and sense of security. We offer an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products that serve over 95 million customers around the world. When you work with us, you’ll enjoy a different kind of career - you’ll make a difference, learn a ton, and change the way people think about health insurance. To see our culture in action, search #TeamCigna on Twitter or Instagram.