Medicare HEDIS Quality Audit Lead Representative – Work from home

By | September 23, 2022

Job Responsibilities : Medicare HEDIS Quality Audit Lead Representative – Work from home

Salary : $22 – $33 an hour

Company : Cigna

Location : Remote US

Remote Work from home

The HEDIS Abstraction Lead Representative works under the direction of the HEDIS Abstraction Lead within the Cigna Medicare Quality Department. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with the HEDIS specifications. The information to be abstracted will be obtained from medical records copied from physician offices/healthcare facilities and sent to CIGNA.

These personnel abstract clinical data into HEDIS nonstandard supplemental sources for HEDIS year round working in partnership with Medicare Quality Stars Network Operations and P4Q Enhanced Care Coordinators (ECCs). They are also responsible for identifying gaps in documentation to share back to providers and market staff for future improvement of HEDIS rates. During the annual HEDIS Medical Record Review (MRR) project (January-May) they also serve as a member of the HEDIS MRR abstraction/over-read team. Must possess proven ability and prior experience using HEDIS software abstraction and identifying medical chart opportunities for providers. Demonstrates understanding of HEDIS technical Specifications and ability to apply knowledge in a fast-paced environment.

Additionally the HEDIS Abstraction Specialist may collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits or may collect the information themselves. All medical records that are copied or received in the Cigna offices must be kept confidential in accordance with federal and local requirements and maintained at the Cigna office. Other duties as assigned to improve HEDIS rates including: gleaning records for additional information utilization research applying measure probability logic to create additional HEDIS chase pursuits and HEDIS MRR measure team lead.


Current RN or LPN/LVN license is preferred.

Three years’ experience with HEDIS MRR or HEDIS abstraction/over-read required.

Experience with data entry and audit of HEDIS -QSHR Inovalon and use of Excel based audit tools preferred.

Intermediate Level experience working with Microsoft Office Products. (Outlook Word Exceland PowerPoint).

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.

For this position we anticipate offering an hourly rate of 22 – 33 USD / hourly depending on relevant factors including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy balanced and feel secure. That’s why you’ll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment you’ll be offered several health-related benefits including medical vision dental and well-being and behavioral health programs. We also offer 401(k) with company match company paid life insurance tuition reimbursement a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs visit Life at Cigna .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health well-being and peace of mind of those we serve. Together with colleagues around the world we aspire to transform health services making them more affordable and accessible to millions. Through our unmatched expertise bold action fresh ideas and an unwavering commitment to patient-centered care we are a force of health services innovation. When you work with us or one of our subsidiaries you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Cigna 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.

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