Job Overview
Location
United States Work at Home
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 15, 2026
Full Job Description
đź“‹ Description
- • The Quality Review & Audit Analyst role at The Cigna Group is critical to ensuring accurate medical coding and compliance with risk adjustment programs, directly impacting the integrity of healthcare data used for reimbursement and quality reporting.
- • Day-to-day responsibilities include conducting medical record reviews with precise ICD-10-CM diagnosis code abstraction, applying HHS Risk Adjustment models to validate Hierarchical Condition Categories (HCCs), performing audits to identify data gaps and compliance risks, and supporting vendor coding partner quality assessments.
- • The role involves collaboration with internal and external stakeholders to deliver Risk Adjustment education, coordinate compliant programs, and escalate risks or gaps to management in a timely manner.
- • The analyst will develop and implement internal processes to ensure CMS/HHS compliance, contribute to Cigna IFP Coding Guideline updates, and gain deep expertise in risk adjustment methodologies, medical documentation audits, and healthcare regulatory standards.
- • This position offers the opportunity to build specialized skills in HCC coding, data validation (including RADV audits), and continuous quality improvement within a national healthcare leader committed to improving health outcomes.
🎯 Requirements
- • High school diploma or equivalent
- • Minimum 2 years of experience with one of the following certifications: CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC; non-CRC certifications require obtaining CRC certification within 6 months of hire
- • Proficiency with ICD-10-CM coding guidelines and conventions, medical documentation audits, and medical chart reviews
- • Familiarity with CMS regulations for Risk Adjustment programs, including inpatient and outpatient documentation requirements
- • Competency with Excel, MS Word, and Adobe Acrobat; detail-oriented, self-motivated, with strong organizational skills
🏖️ Benefits
- • Comprehensive health benefits including medical, vision, dental, and well-being/behavioral health programs starting on day one
- • 401(k) retirement plan, company-paid life insurance, and tuition reimbursement
- • Minimum of 18 days of paid time off per year plus paid holidays
- • Eligibility for an annual bonus plan
- • Remote work option with requirement for cable broadband or fiber optic internet (10Mbps download/5Mbps upload)
Skills & Technologies
About The Cigna Group
The Cigna Group is a global health services company formed in 1982 through the merger of Connecticut General and INA Corporation. It provides medical, dental, disability, life and accident insurance, pharmacy benefit management, and behavioral health services to employers, individuals and government entities. Headquartered in Bloomfield, Connecticut, the company operates in over 30 countries and jurisdictions, serving more than 180 million customer relationships worldwide through its subsidiaries and affiliates.
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