Medicare Provider Performance Lead Analyst- Hybrid- Cigna Healthcare- Atlanta, GA

2 months ago

Atlanta, Georgia, United States The Cigna Group Full time
The job profile for this position is Network Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

THIS ROLE REQUIRES 50% LOCAL TRAVEL IN ATLANTA, GA AREA

Job Summary:

The Provider Performance Lead Analyst is a key member of the market that assists in the growth and development of the provider network. The Lead Analyst is the primary conduit to the providers and the individual that represents Cigna MA.

The Provider Performance Lead Analyst's responsibilities include:

  • Supporting the development, management and oversight of the physician/ provider network in his/her assigned territories.
  • 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

Role Components

All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:

Growing the MA Business

The Provider Performance Lead Analyst is accountable for the growth of the assigned territories in terms of financial profitability, engagement of provider network and membership growth.

Delivering our Services

The Provider Performance Lead Analyst is accountable for the exceptional delivery of services in the assigned territories as evidenced by physician and member satisfaction, improvements on Stars and NPS score.

Managing our Costs

The Provider Performance Lead Analyst assists in ensuring the affordability of services in the assigned territories by applying his/her influence, where applicable, to various cost levers within his/her control.

Collaborating with our Partners

The Provider Performance Lead Analyst seamlessly collaborates with all applicable partners to solve outstanding issues and may lead initiatives within his/her territory that improve service delivery within the business or assist in other special projects.

Minimum Qualifications and Competencies

  • Bachelor's degree preferred or 3+ years of direct experience with health plan operations, preferably specific to government sponsored health plans, or equivalent work experience.
  • Ability to apply an enterprise mindset with business acumen resulting in meeting goals in growth and profitability
  • Minimum of 2 years' experience with Medicare Advantage plans
  • Minimum of 2 years' experience with Provider Performance
  • Minimum of 2 years' experience of Provider facing experience
  • Strong presentation skills
  • Shows ability to think strategically, customer focus and ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
  • Capacity for leading initiatives and influencing people on teams
  • Microsoft Office Suite experience
  • Ability to develop strong relationships across multiple levels of the organization
  • Effective communicator

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.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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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