Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager, Director, and Other Administrators. Provider Performance Enablement (PPE) is responsible for the financial and operational activities of provider networks and this position involves extensive interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of a Coordinated Care Organization (financial understanding, provider network building, conflict/issue resolution, contracting, claim payment, meetings, training, etc.). RESPONSIBILITIES: Educating providers and office staff on health plan initiatives, contracts, policies, and procedures. Managing monthly communications and face to face provider visits and calendar of events. Maintain contracted provider demographic records by validating and submitting all data management requests for completion. Prepare for and participate in meetings with providers, provider staff, and/or physician leadership. Manage joint operations committee (JOC) meetings. This includes: formulating meeting agenda, and recording minutes from meeting. Planning, creating, and delivering presentations. Partners with other internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop solutions for strategic business needs. Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding, and STARs/quality performance Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives Perform financial analysis & participate in market financial review with senior management. Trouble shoot claims issues for providers Investigate member grievances within network. Attend various meetings and assist with facilitation Misc.-Administrative Responsibilities QUALIFICATIONS: Bachelor's Degree strongly preferred. 2+ years' experience in customer service, claims, and/or payor related experience Demonstrated knowledge of contracting process, Medicare fee schedules, financial terms, and metrics strongly preferred Proficient at Microsoft Office products, particularly Excel and PowerPoint. Excellent communication skills. LOCATION REQUIREMENTS Desired work location: Tuscon, AZ - Pima County Field work - approximately 3 days weekly, local travel (Position requires that the time be spent primarily externally with administrative support). Reliable transportation and valid driver's license Mileage reimbursement provided
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.
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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.
