Medicare Provider Performance Enablement Lead Analyst

2 months ago

Huntsville, Alabama, United States The Cigna Group Full time

North Alabama based - Medicare Provider Performance Enablement (PPE) Lead Analyst provides broad support to 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.).

The Provider Performance Lead Analyst's responsibilities include:

  • Supporting the development, management and oversight of the physician/ provider network in the assigned in North Alabama
  • Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g. physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.
  • Educating providers on the performance requirements associated with value-based contracts.
  • Conducting regular provider visits to educate providers and office staff on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment, medical cost management, etc.
  • Schedules, prepares for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations.
  • Collaborating with Provider Performance Senior Manager/Manager on strategic plans on growth, development, and vision for assigned territory. Participating with the Senior Manager/Manager in monthly financial review.
  • Assisting in initiatives and performing special projects and other duties as assigned by leadership
  • Developing time and cost effective territory management in compliance with department and enterprise goals.
  • Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and Stars/quality performance.
  • Partnering with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Sales & Risk Adjustment in order to develop solutions for strategic business needs

QUALIFICATIONS:

  • Bachelor's Degree or relative work experience required
  • 3+ years' experience in customer service, claims, and/or payor related experience
  • Direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage strongly preferred
  • 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: North Alabama - Huntsville and surrounding area
  • 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.

If you require reasonable accommodation in completing the online application process, please email: for support. Do not email 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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