Network Operations Lead Analyst
CignaRemote17 days ago
This individual reports directly to the Network Operations Manager and serves as a primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization. Develops and maintain positive relationships with providers and other cross-functional, cross-collaborative team including Network operations, Sales, Health Services, Coding, Finance, Marketing, Stars and Commercial Contracting. Will also support the activities of the Network Operations Department.
- Lead the contracting of tier 2 and 3 providers (including hospital, ancillary, and physician); as needed, negotiation of managed care contracts including appropriate capitation, fee-for-service reimbursements, and contractual language.
- Assist in coordinating provider agreements, amendments, and letters of agreement with non-contracted providers as needed by manager and/or director
- Responsible for the strategy and execution of stars, coding, and unit cost performance of assigned territory.
- Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality, coding, service line initiatives and financial performance.
- Maintain internal partnership with medical economics, legal, health services, provider data management to operationalize contracting by meeting agreed parameters with legal counsel to lessen risk and improve operational efficiencies.
- Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding and Stars/quality performance; support coding and stars initiatives through network operations initiatives and contract negotiations.
- Maintain provider file folders in master files and online databases
- Complete and maintain provider rosters reflecting accurate demographic information.
- Perform special projects and other duties assigned by leadership.
- Requires 25-50% local travel to providers
Provider Orientations and Operational Meetings
- Organizes and conducts operating committee meetings with provider/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities
- Gather operational concerns expressed at operational meetings and work with Administrator or Director to resolve any operational issues
- Initiates and maintains effective channels of communication with providers, office staff and matrix partners
- Claims and Operational issues with Providers
- Research and investigate provider concerns regarding claims payment, appeals, and resolution of operational issues. Coordinate with Claims Department to research and resolve provider concerns
- Respond to provider questions, phone calls, and inquiries in a timely fashion.
- Other Duties and Responsibilities
- Assist in analysis of monthly cost trends for the direct market
- Recommend solutions and assist in identifying action plans to remediate provider medical cost trends.
- Participate in regularly scheduled meetings with other departments; offer substantive feedback to questions and research thoroughly any unknown issues
- Be available during working hours to coworkers and others for questions; including multitasking on calls and other similar scenarios
- Other duties and responsibilities as assigned
- Bachelor’s degree and/or equivalent work experience of 3 or more years in Medicare based or Medicare Advantage required
- Additional Skills: Excellent presentation, communication and customer service skills required. Excellent time management and relational skills. Demonstrated analytical skills. Strong organizational abilities with attention to detail.
- Computer Skills: Microsoft Word, Excel, PowerPoint
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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.