Full Job Description
Quality Review and Audit Lead Representative- HEDIS Chart Abstraction Specialist
Location: Remote, Work at Home Opportunity
The HEDIS Quality Review and Audit Lead Representative works under the direction of the HEDIS Audit Lead within the Cigna Medicare Quality Department. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with the HEDIS specifications. The clinical information to be abstracted will be obtained from medical records copied from physician offices/healthcare facilities and sent to the CIGNA HealthCare office.
This person will may also be a key HEDIS audit personnel, auditing supplemental sources for HEDIS abstraction accuracy year round, then converting to an audit abstraction/over-read role during official HEDIS MRR (Medical Record Review). Must possess proven ability and prior experience using HEDIS software, Excel based audit and targeting reports. , and working within an audit team to evaluate HEDIS accuracy. Demonstrates understanding of HEDIS technical Specifications and ability to apply knowledge in a fast paced environment.
How you'll make a difference:
The HEDIS Abstraction and Audit Specialist may collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits or may collect the information themselves. All medical records that are copied or received in the Cigna offices must be kept confidential, in accordance with federal and local requirements, and maintained at the Cigna office. Other duties as assigned to improve HEDIS rates including: gleaning records for additional information, utilization research applying measure probability logic to create additional HEDIS chase pursuits, and HEDIS MRR measure team lead.
Current RN or LPN/LVN license is preferred.
High school diploma required
Prior HEDIS MRR experience required.
A minimum of three years’ experience with HEDIS MRR or HEDIS abstraction/over-read required.
Experience with data entry and audit of HEDIS QSI -QSHR Inovalon, and use of Excel based audit tools preferred.
Able to work independently and meet productivity expectations
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.