The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical
Condition Category expertise to the role, evaluates complex medical conditions, determines
compliance of medical documentation, identifies trends, and suggests improvements in data and
processes for Continuous Quality Improvement (CQI).

Key Job Functions:

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with

Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS

Protocols and any additional applicable rule set.

• Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories

(HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.

• Apply longitudinal thinking to identify all valid and appropriate data elements and

opportunities for data capture, through the lens of HHS’ Risk Adjustment.

• Perform various documentation and data audits with identification of gaps and/or inaccuracies in

risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA)
programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis

submission program. Inclusive of Quality Audits for vendor coding partners.

• Collaborate and coordinate with team members and matrix partners to facilitate various aspects

of coding and Risk Adjustment education with internal and external partners.

• Coordinate with stake holders to execute efficient and compliant RA programs, raising any

identified risks or program gaps to management in a timely manner.

• Communicate effectively across all audiences (verbal & written).
• Develop and implement internal program processes ensuring CMS/HHS compliant programs, including

contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed.
Education & Experience:
The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience

Please refer the Job description for details