Cigna
Legal Compliance Advisor- Medicare Part C Risk Adjustment Monitoring and Audit (Finance)
To be successful, this candidate must exhibit superior analytical, coding skills (including ICD-9 and ICD-10), strong knowledge of HCC's and risk scores, communication and collaborative skills, as well as the ability to excel in a dynamic, fast-paced environment. The candidate must demonstrate solid command of risk adjustment. This compliance team member must be adept at working with a variety of internal and external stakeholders. S/he will promote an enterprise-wide culture of compliance and provide first-rate support within the Compliance Department and across the business units.
Qualifications:
Bachelor's degree or equivalent.
5+ years of experience with Medicare Risk Adjustment-is required.
5+ years of experience working with Medicare Advantage, Medicare-Medicaid. Plan (Dual-Eligible) and/or Medicaid.
Certified Coding Specialist required.
5+ years of experience with auditing.
Experience with Risk Adjustment Data Validation Audits required.
Strong knowledge of Medicare Risk Adjustment regulations required.
Strong knowledge of Risk Adjustment and Hierarchical Condition Category
Payment model (i.e., v12 and v22) required.
This is Hybrid role and requires someone to be in office 3 days a week.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
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.
Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.