Senior Analyst – Cigna Remote Jobs

Job Type: Senior Analyst from home
Location: Pennsylvania work from home
Company: Cigna

The Senior Analyst for Provider Performance Enablement will play a significant role in the Medicare Advantage Pennsylvania/Delaware market. They will oversee all contracts between independent professional providers in a certain region, reporting to the Provider Performance Enablement Manager. To promote engagement and performance optimization, this position acts as the main point of contact for staff and providers.

Responsibilities:

• Accountable for directing independent professional service providers within a designated area to advance connections along the value-based continuum.
• By planning and leading meetings to talk about policies and procedures, utilization, STARS, risk-adjustment, and growth initiatives, you are responsibly creating relationships with providers.
• Establishes and maintains efficient lines of communication with service providers, office personnel, and matrix partners, including those for medical economics, legal compliance, sales, marketing, claims, health services, quality, and contracts.
• recognizes, creates, tracks, and reports on important program performance measures, including trends in medical cost, risk-adjustment, and STARS performance.
• Promote the expansion of value-based contracting and clinical data integration in a designated area through increased provider engagement.
• carries out STARS and risk-adjustment programs by putting action plans into place to correct deplorable performance tendencies.
• By collaborating with matrix partners to review and identify new providers to increase marketability and approve providers/groups requesting involvement with Cigna Medicare, supports the development of the provider network.
• Carries out internal checks to ensure the accuracy of provider data, supports internal teams in updating the Online Provider Directory (OLPD), prioritizes provider claims issues, and makes use of internal tools to handle data and report.
• Acts quickly to do research on problems reported by providers or matrix partners. gives ongoing input and does follow-up to encourage resolution.
• Accountable for ensuring adherence to CMS and corporate rules and regulations.
• Whenever necessary, take on expanded market duties.
• Car and current driver’s license necessary; reimbursement for travel expenses granted.
• 50–75% of the travel for this job will go to providers in the local area.

Requirements:

Required

• GED or a high school diploma
• Knowledge sharing skills and a willingness to instruct, mentor, and coach people with various degrees of experience.
• Detail-oriented with strong organizational and time management abilities (including the capacity to handle several activities and adhere to deadlines/standards).
• Ability to learn rapidly, solve problems independently, and make judgments in a changing work environment.
• The capacity to regularly do cross-functional research and find solutions to difficult provider issues.
• Think strategically; have excellent negotiating, analytical, and problem-solving abilities.
• Strong oral, written, and presentational communication skills.
• Developing external relationships while placing a big emphasis on customer service.
• A working knowledge of spreadsheet, email, and Microsoft Office.

Preferred

• With relevant professional experience and a bachelor’s degree in a related discipline.
• Experience with Medicare Advantage for two years or more.
• Understanding of system applications, processes, and provider onboarding.
• Excellent leadership qualities and the capacity to interact with cross-functional leadership successfully.
• Competence to handle projects using tried-and-true project management techniques.
• Expertise in network creation involving complicated hospital systems, integrated delivery systems, and sizable physician groups, as well as provider contracting, value-based contracting, and risk agreements (IPAs and PPMs).
• Good understanding of the regulatory environment, compliance challenges, and managed care (e.g., network architecture, products, customer service, provider communities, etc) (e.g. NCQA accreditation issues, credentialing, delegation and oversight standards, etc.).

Whether you intend to work from home on a regular basis or infrequently, you must have an internet connection from a cable broadband or fiber optic internet service provider with minimum download and upload speeds of 10 Mbps and 5 Mbps, respectively.