Job Description
This is a temporary role through PRO Unlimited with one of the world’s leading health insurance companies.
Quality Review & Audit Senior Representative
Chart Administration & Interoperability
Job Summary:
The Quality Review & Audit Senior Representative supports Cigna’s Individual and Family Plans (IFP) Risk Adjustment Chart Administration program under the direction of management through day-to-day chart retrieval, processing, and administrative tasks.
Core Responsibilities:
• Monitors all chart retrieval activities for IFP projects, and performs such actions as defined by department workflows, including tasks such as tracking outstanding records, evaluating chart availability, reviewing for completeness & image quality, routing charts to the appropriate location, problem-solving with retrieval vendors, and recording activities in the designated application.
• Performs outreach via telephone or secure fax to provider offices for requests including but not limited to additional information required, record delivery, retrieved record deficiencies, and signature deficiency attestation completion, as needed.
• Ensures confidentiality and security of Cigna customer PPI/PHI by following all HIPAA, regulatory, and Cigna processes and release-of-information protocols.
• Follows Cigna medical records policies for storage and retention.
• Maintains a daily production tracker in a predetermined format, submitting to Supervisor in a weekly cadence.
• Performs chart processing, vendor pend resolution, provider research, and other tasks as required to execute IFP Risk Adjustment programs.
• Demonstrates clear, concise, and professional communications with peers and supervisors, in verbal, telephonic, and written communication.
Minimum Qualifications:
• High School Diploma or equivalent
• Knowledge of medical records, including basic medical terminology
• Basic knowledge of Microsoft Excel, Outlook management, Adobe and Word
• Ability to work as a team and individually on time-sensitive projects.
• Must be detail oriented, able to multi-task, accurate in data entry, able to follow directions, and able to apply criteria for multiple measures.
• Skilled in use of basic office equipment (i.e., fax, photocopying equipment, printer, etc.)
• General understanding of healthcare privacy regulations is desirable; training will be provided.
• Candidate must possess a professional appearance, have good oral and written communication skills, be self-directed, and well-organized.
• Prior experience with working with medical records preferred.
• Prior experience with working with EMR/EHR systems is preferred but not required.
• Experience with HCC coding preferred but not required.
Top Skills:
• Knowledge of medical records, including basic medical terminology
• Basic knowledge of Microsoft Excel, Outlook management, Adobe and Word
• Ability to work as a team and individually on time-sensitive projects
• Must be detail-oriented, able to multi-task, accurate in data entry, follow directions, and apply criteria for multiple measures.
Location:
• Hybrid
Hourly Pay Rate Range (dependent on location, experience, and expectation)
• The pay range that Magnit reasonably expects to pay for this position is $18.11-24.14/hour.
• Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met)