Coding Quality Specialist - Certified Coder Required
Cigna - Baltimore, MD

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Job Description

HealthSpring, a Cigna company, is one of the country's leading health plans focused on delivering care to the senior population, predominately through Medicare Advantage and other Medicare and Medicaid products. Along with its companies Bravo Health and Leon Medical Centers Health Plans, HealthSpring serves more than one million customers in locations across the country. Based in Nashville, Tennessee, HealthSpring operates health plans in Alabama, Delaware, Florida, Georgia, Illinois, Maryland, Mississippi, New Jersey, Pennsylvania, Tennessee, Texas, West Virginia and Washington, D.C. HealthSpring also offers a national stand-alone prescription drug plan. For more information, visit

Coding Quality Specialist

Responsible for reviewing and auditing coded records across markets for coding quality. Responsible for reporting findings, making recommendations, and creating action plans.

Additional responsibilities:
  • Responsible for conducting reviews/audits on coded records to ensure that the assigned ICD code(s) follow guidelines and are supported by the clinical documentation.
  • Responsible for reporting findings for proper distribution and education. Ensures policies and procedures are monitored and updated to include regulatory changes.
  • Responsible for reporting findings, making recommendations and creating action plans for distribution to the appropriate coding teams.
  • Ensures compliance with recommendations.
  • Responsible for reporting trends and suggesting processes to monitor and/or improve areas of need discovered during review/audit.
  • May act as team lead for a team of Provider Coding Specialists
. Requirements

Minimum Requirements for the Coding Quality Specialist includes the following:

Bachelor’s Degree is preferred and at least three years of coding experience is required.

Some type of coding certification is also required and may include the following:

1 Certified Professional Coder (CPC),
2 Certified Coding Specialist for Providers (CCS-P),
3 Certified Coding Specialist for Hospitals (CCS-H),
4 Registered Health Information Technician (RHIT),
5 Registered Health Information Administrator (RHIA), .

Additional requirements for this opportunity include:
  • Extensive knowledge of ICD-9-CM/ICD-10-CM, CPT, and CMS coding principles and guidelines. (Diagnostic coding experience is highly preferred.)
  • Prior audit / quality experience.
  • At least two years managed care experience.
  • Familiarity with physician-specific regulations and polices related to documentation and coding.
  • Knowledge of Medicare Risk Adjustment guidelines.
  • Proficiency with ICD-9-CM/ ICD-10-CM coding.
  • Must be detail oriented, self motivated, and have excellent organization skills.
  • Proficient in Microsoft Office products, specifically Excel. .

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