Job Description

Hybrid Role

Must reside near Philadelphia, PA

Summary

The Provider Performance Enablement Sr. Analyst will be a key representative in Medicare Advantage Pennsylvania/Delaware market. Reporting to Provider Performance Enablement Manager, they will provide oversight for all independent professional provider relationships in an assigned territory. This role serves as a primary contact for providers and staff to drive engagement and performance optimization.

Responsibilities

• Oversees independent professional providers in an assigned territory with accountability to progress relationships along the value-based continuum.
• Responsible developing relationships with providers through organizing and conducting meetings to discuss policies and procedures, utilization, STARS, risk-adjustment, and growth initiatives.
• Initiates and maintains effective channels of communication with providers, office staff and matrix partners including: medical economics, legal, compliance, sales, marketing, claims, health services, quality, and contracting.
• Understands, develops, monitors and reports on key program performance metrics, such as medical cost trends, risk-adjustment and STARS performance.
• Drive the growth of value-based contracting and clinical data integration through improved provider engagement in an assigned territory.
• Executes risk-adjustment and STARS initiatives by implementing action plans to remediate negative performance trends.
• Supports development of the provider network by working with matrix partners to review and identify new providers to improve marketability and approve providers/groups seeking participation with Cigna Medicare.
• Conducts internal audits for provider data accuracy, assist internal teams with updating the Online Provider Directory (OLPD), triage claims provider claims issues and utilizes internal systems to manage data/reporting.
• Acts with a sense of urgency to research on issues brought by providers or matrix partners. Provides on-going feedback and follow up to drive to resolution.
• Responsible for maintaining compliance to CMS and company policies and guidelines.
• Assume broader market responsibilities as warranted.
• Car and valid driver\xe2\x80\x99s license required - mileage reimbursement provided.
• This role will require 50% or more of local travel to providers.

Qualifications

Required

• Ability and willingness to share knowledge as well as train, develop, and coach individuals with varying levels of experience.
• Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).
• Aptitude to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with minimal supervision.
• Ability to work cross-functionally to research and resolve complex provider issues on a regular basis.
• Strategic thinker, strong negotiation, analytical and problem-solving skills.
• Excellent presentation, oral, and written communication skills.
• External relationship building with a strong focus on customer service.
• Proficient knowledge of Microsoft Office; e-mail and spreadsheet software.

Preferred

• 2+ years of Medicare Advantage experience.
• Knowledge of provider onboarding process, system applications, and procedures.
• Strong leadership skills and the ability to effectively engage with cross functional leadership.
• Demonstrated ability managing projects, utilizing proven project management processes.
• Experience in provider contracting, value based contracting and risk arrangements and network development involving complex hospital systems, integrated delivery systems and large physician groups (IPAs and PPMs).
• Strong knowledge of managed care (e.g. network design, products, customer service, provider communities, etc.) regulatory environment and compliance issues (e.g. NCQA accreditation issues, credentialing, delegation and oversight standards, etc.).

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.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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.

The Cigna Group 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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