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Home » Cigna Internship Summer 2023 – Provider Education Senior Analyst In St. Louis

Cigna Internship Summer 2023 – Provider Education Senior Analyst In St. Louis

    Website Cigna

    Job Description:

    This role is responsible for supporting Cigna Medicare Advantage’s Risk Adjustment & Stars program for assigned populations in an operational market. The role will be accountable for assigned provider groups reaching risk adjustment and stars related annual metrics. This role will work directly with providers to assist in achieving accurate and complete coding documentation and addressing Stars gaps in care. The role will work under the direction of Risk Adjustment & Stars Provider Education Supervisor and/or Manager to reach overall operational market goals in conjunction with market network operations, stars strategy and vendor 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.

    Job Responsibilities:

    • Work closely with matrix partners including Network Operations, Stars or Clinical Operations, and vendors to ensure provider office communications are effective and efficient.
    • Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk
    • Adjustment program to ensure correct coding and documentation.
    • Maintain CEU credits to ensure credentials are kept up to date.
    • Develop relationships with clinical providers/staff and communicate coding and documentation guidelines.
    • Perform the minimum number of coding quality reviews consistent with established departmental goals.
    • 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.
    • Accountable to complete and accurate review of multi-year diagnosis coding of assigned population.
    • Assists with research, analysis and response to inquiries from all internal and external audit departments regarding compliance, coding, and inappropriate coding.
    • Conduct chart reviews for providers and review provider performance. This is accomplished by doing virtual training sessions, traveling to the individual practices and/or performing side-by-side education.
    • 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.
    • Attend risk adjustment and quality provider meetings for assigned provider groups to provide updates, recommendations, or education (may occur be before/after normal business hours)
    • Understands, develops, tracks, monitors and reports on key program performance metrics for coding initiatives.
    • Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data.
    • Assure compliance by delivering quality services and meeting all contractual, state & federal legal and regulatory requirements.
    • Maintain strictest confidentiality based on HIPAA privacy policy.
    • Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, HCPCS
    • Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups (PODs/IPAs).

    Job Requirements/Qualifications:

    • Strong negotiation, presentation, analytical and problem-solving skills.
    • Five years or more of experience working with value-based contracts, preferred
    • Five years or more of experience working with physician organizations, preferred
    • Advanced knowledge of Microsoft Office, especially Excel advanced functions.
    • Bachelor’s degree in Business Management, Health Policy or Administration, or related field, preferred
    • Ability to work with cross-functional teams to accomplish multiple project objectives
    • Understanding of value-based reimbursement and ability to learn in-depth program details
    • Excellent communication skills – verbal, written and presentation.
    • Ability to manage multiple provider relationships
    • Foundational understanding of health care informatics (i.e. PMPMs, Utilization rates, risk adjustment, evidence based or quality metrics)
    • Ability to efficiently conduct meetings and presentations
    • Ability to query data preferred
    • Excellent written and oral communication and presentation skills
    • Demonstrated ability to identify action items and execute appropriate and timely follow-up

    To apply for this job please visit jobs.cigna.com.


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