Quality Review & Audit Senior Representative - Cigna Healthcare - Remote

Cigna Healthcare

1d • Remote

About The Position

Supports Cigna’s Risk Adjustment program by performing Quality Assurance, audit, and medical record chart retrieval activities. Independently completes day‑to‑day quality reviews and audits with limited supervision, escalating non‑routine issues as needed. Identifies process improvement opportunities and assists with the development of audit guidelines. This role focuses on auditing, troubleshooting, and resolving issues related to the retrieval, processing, and quality of medical records while ensuring compliance with HIPAA and Cigna policies.

Requirements

• High School Diploma or equivalent.
• Knowledge of medical records and basic medical terminology.
• Basic proficiency with Microsoft Excel, Outlook, Word, and Adobe.
• Strong attention to detail, data accuracy, and ability to multitask.
• Ability to work independently and collaboratively on time‑sensitive work.
• Ability to identify issues requiring escalation.
• General understanding of healthcare privacy regulations.
• Clear, professional verbal and written communication skills.
• 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.

Nice To Haves

• Prior experience with medical records and EMR/EHR systems preferred.
• Experience with HCC coding preferred but not required.

Responsibilities

• Monitor and manage chart retrieval activities for IFP projects, including tracking outstanding records, identifying retrieval barriers, evaluating chart availability, and reviewing records for completeness and image quality.
• Route charts appropriately, document activities in designated systems, and resolve issues with retrieval vendors.
• Conduct outbound outreach to provider offices via phone or secure fax to request records, resolve deficiencies, and obtain required attestations.
• Perform daily quality audits of vendor submissions, provider responses, and related retrieval requirements.
• Ensure confidentiality and security of PPI/PHI and adhere to HIPAA, regulatory, and Cigna policies.
• Maintain production tracking and required reporting.
• Perform chart processing, vendor pend resolution, provider research, and other support tasks as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED