Medical Administrative Senior Representative

  • Location

    Nashville, United States

  • Sector:

    Other Area(s)

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    over 1 year ago

  • Expiry date:


CMS conducts RADV audits. (Risk Adjustment Data Validation). The goal of the RADV audit is to ensure that the carrier has submitted accurate risk adjustment information to CMS. As part of RADV Cigna collects Medical Records from providers and packages them in the way CMS requires for audit purposes. The individual in this role will be conducting various administrative tasks to support the audit, as outlined in the job description.

Delivers specific delegated Clinical Operations tasks assigned by a supervisor. Completes day-to-day Medical Administration tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.

This position is responsible for verifying, and preparing IFP medical records for processing. The position supports Risk Adjustment and audit projects under the direction of the Medical Records Supervisor with oversight from the RADV Project Leader and Operational Director. Responsibilities may also include:

Provide quality review on returned medical records to ensure the records are legible and contain customer identifying information, such as name and date of birth

Sort and scan incoming records to the proper work area in the workflow

Process incoming records to the proper work flow - RADV audit software

Contacting provider offices for additional missing information

Faxing and/or mailing provider offices audit specific requests

Maintaining a daily production sheet

Maintaining an organized filing system electronically

All medical records that are copied or received must be kept confidential in accordance with federal and local requirements and maintained within the CIGNA approved storage systems.