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Prospective Program Solutions

3 months ago

Independence, Ohio, United States Cigna Full time
Job Description

This role is responsible for supporting Cigna Medicare Advantage risk adjustment programs, solutions, and performance in aligned operational region serving as a liaison between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams.

The Prospective Program Solutions & Performance Advisor collaborates with aligned region supporting risk adjustment initiatives and programs aimed at enhancing accuracy and completeness of risk adjustment, advising the market on risk adjustment strategy based on knowledge of Cigna MA's overall Risk Adjustment programs, with a strong focus on alternate programs and bi-directional data exchange initiatives, and overseeing regional and market program performance. This work includes support in initial provider engagement, implementation bridge, workflow optimization, and successful program participation. The expectation will be offering solutions for short term and longer team participation in Cigna RA programs.

The role reports to the Senior Manager - National Lead Provider Education to achieve operational market goals in conjunction with market Provider Performance Enablement teams and the Risk Adjustment Operations team. Expertise required includes performance management/analytics, data exchanges, electronic medical record systems, provider workflow and processes, health information management, risk adjustment operations, value-based care, ICD-10, CPT and HCPCS coding principles, and population health management.

Incumbent candidate must be able to work a hybrid schedule and report to one of the following office locations as needed:

  • Philadelphia, PA
  • Morris Plains, NJ
  • Morristown, NJ
  • New York City
  • Chicago, IL
  • Independence, OH
  • Westerville, OH
  • Pittsburgh, PA

Core Responsibilities:

  • Understanding provider workflow and processes to support risk adjustment accuracy and completeness for Cigna MA. Working with market/PPE teams and provider group to ensure effective process to address gaps in care for Cigna customers.
  • Acting as a liaison to share updates on risk adjustment programs and strategy with markets/PPE team. Serving as a strategic advisor for market specific risk adjustment strategy and solutions. Communicating program status updates on aligned work to leadership and key stakeholders.
  • Providing regular updates on risk adjustment metrics and program performance at market and regional levels. Identifying areas for improvement and working with markets to build solutions.
  • Identifying and resolving issues related to market-specific RA needs.
  • Working with matrix partners and provider groups to identify modality for program participation, creating implementation plans and timelines for successful launch. Coordinating with Provider Education team.
  • Functioning as a Risk Adjustment and Quality SME to support engaged market and matrix partners. Providing visibility on providers' progress and serving as a bridge for implementation discussions.
  • Supporting RA focused meetings and initiatives for national global groups.
  • Identifying processes to enhance risk adjustment accuracy. Attending provider meetings as needed to support key functions.
  • Keeping updated on industry standards, coding guidelines, and regulations. Utilizing standard tools to advise market partners.
  • Maintaining compliance and CEU credits. Supporting multiple regions with projects when needed.
  • Supporting additional Risk Adjustment and ad-hoc projects.

Requirements:

  • 7+ years of experience with provider groups and/or health systems in risk adjustment.
  • Certification in Documentation Integrity, Coding, or Health Information Management preferred.
  • Experience in healthcare payer/provider operations, CMS Risk Adjustment, HCC coding, and quality measures.
  • Experience with EMR implementations, data platforms, and data feeds preferred.
  • Strong time management skills, communication, and facilitation skills.
  • Experience in initiating, tracking, and managing business initiatives.
  • Ability to identify and track measurements for optimal outcomes.
  • Strong critical thinking skills and proficiency in computer skills.
  • Travel may be required.

If working from home, a cable broadband or fiber optic internet with specific speeds is required. Anticipated annual salary of $72,600 USD with eligibility for an annual bonus plan.

Comprehensive benefits include medical, vision, dental, well-being programs, 401(k) with company match, life insurance, tuition reimbursement, paid time off, and holidays. Visit Life at Cigna Group for more details.

About Cigna Healthcare

Cigna Healthcare advocates better health through every life stage, guiding customers with information to make informed health choices. Join in driving growth and improving lives.

Qualified applicants will be considered without regard to various characteristics. Reasonable accommodation requests can be made during the application process. Tobacco-free policy in place for hiring.