Risk Adjustment Provider Education Lead Analyst - Mid Atlantic - Cigna Healthcare - Mid-Atlantic

Incumbent candidate must reside in assigned territory and have the ability to travel to the local office and provider offices in the territory.

Candidate can be based out of Baltimore, MD office or McLean, VA office.

This position cannot be performed remotely.

Incumbent candidate must be hybrid, working 3 days per week in assigned local office.

Selected candidate will be awarded a one-time sign-on bonus of $5,000 in addition to base salary.

This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational market.

The role will be accountable for assigned provider groups reaching risk adjustment related annual metrics.

This role will work directly with providers to assist in achieving accurate and complete coding documentation.

Provider Data Lead Analysts will be responsible for the most complex provider groups along the engagement continuum within an assigned market.

Lead Analyst will be primary contact for provider groups on Risk Adjustment topics at joint operating meetings, quality meetings, etc.

Lead analysts may be asked to provide coaching and support to senior analysts, lead representatives, or other team members to achieve Risk Adjustment goals.

The role will work under the direction of Risk Adjustment Manager to reach overall operational market goals in conjunction with market matrix partners.

The role will provide subject matter expertise to assigned providers and internal matrix partners of Cigna Medicare's programs specific to CMS Risk Adjustment and HCC Coding Processes.

It will require expertise in ICD-10-CM/outpatient and CPT coding principles and guidelines and use of own discretion to deliver compliant, effective strategies to meet established goals.

Core Responsibilities:


* In partnership with Risk Adjustment Manager, support the training and development of Senior Analysts and Lead Representatives.


* Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups (PODs/IPAs).


* Accountable to complete and accurate review of multi-year diagnosis coding of assigned population.


* Understands, develops, tracks, monitors, and reports on key program performance metrics for coding initiatives.


* Work closely with matrix partners to ensure provider office communications are effective and efficient.


* Review and act on any assigned audit educational opportunities timely and provide primary care or specialty care provider trainings as necessary to educate on audit findings.


* Analyze data regarding trends or patterns identified in provider office diagnosis coding.

Implement provider office education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards.


* Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/ed...