Job Summary:
This role is a member of the Encounters Risk Adjustment Submissions team. This team is dedicated to submitting risk adjustment data to CMS on behalf of Cigna HealthSpring to support Encounter operational programs. This position requires experience in both analyzing medical data and information systems. The individual must be motivated by desire for success and pursuit of excellence.
Principal Duties:
Focuses on the use of information and analytics to improve health and optimize consumer focused business processes.
Possess technical knowledge of all phases of applications systems and operational processes.
Validates data, performs data analysis, loads data into appropriate systems and organizes it to get meaningful reports.
Required to review, designs, and prepares application/system specifications across multiple platforms for information systems solutions which address business needs and methods.
Conducts testing and system validation to troubleshoot issues related to master data management and system integrity.
Recommends ways to strengthen data integrity, quality, and availability across the organization.
Collaborate with client management to identify and specify the complex business requirements and processes, and in the application design, testing and implementation processes.
Broker conversations to remediate data issues while building a rapport and a positive working relationship with internal and external business partners, stakeholders, and team members.
Give outstanding customer service to everyone you meet or work with.
Strive to obtain the support, engagement and effort needed to successfully complete tasks as assigned.
Minimum Qualifications:
Bachelor's Degree in Statistics, Mathematics, Computer Science or High School Diploma with a minimum 4 years' experience in related health care analytics or any combination of education and healthcare experience.
Knowledge of CPT, HCPS, ICD9 and ICD10 codes.
Knowledge of 5010, x12 EDI, Standardized Medical formats.
Excellent oral, written presentation and communication skills.
Strong analytical and creative problem-solving skills.
Experience utilizing and optimizing SQL statements.
Familiar with IT Software Development Lifecycle (SDLC)
Preferred Qualifications:
Knowledge of Medicare Advantage Risk Adjustment Model (HCC model)
Knowledge of with NUCC and NUBC guidelines
Knowledge of Medicare Regulations and Medicaid State Processing Guidelines
Experience in working on an Agile team and understanding of Agile methodologies.
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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
