- Direct support to network management team members to facilitate evaluation and implementation of appropriate Medicare Advantage participation terms.
- Production and guidance on approved contract language for Medicare Advantage products by the contractors
- Ensure appropriate legal department approval on non-standard contract terms.
- Monitoring adherence to policies and processes for managing Medicare Advantage hospital, facility and ancillary contracting responsibilities performed by the Tennessee contracting department.
- Timely submission of provider contract, demographic, credentialing, and other information to applicable Medicare Advantage departments.
- Review and corrective actions for accuracy of Medicare Advantage provider directories and listings.
- Produce reporting required by, and respond to requests from, Senior Segment related to the Medicare Advantage facility and ancillary participating providers.
- Coordination and tracking of necessary disclosure to / approval from Senior Segment leadership on key Medicare Advantage contract terms.
- Interface with Medicare Advantage Medical Economics team to ensure (1) due diligence performed on financial analysis on contract terms and network strategies, and (2) there is a uniform understanding of Medicare Advantage financial terms between key stakeholders (incl. Senior Segment and commercial health plan).
- Direct contracting relationship and negotiation for Tennessee facilities and ancillary providers (1) contracted specifically for the Tennessee market, (2) otherwise not participating for MA through a Cigna national contracting team (commercial or MA), (3) otherwise not participating though a local Tennessee commercial contract, or (4) as otherwise requested.
- Other responsibilities as assigned by the Medicare Contracting Senior Advisor (M
- Bachelor's degree strongly preferred in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree.
- 1+ years of Provider Contracting and Negotiating for Healthcare Hospital/Provider/Ancillary group experience required
- 1+ years prior Provider Servicing experience strongly preferred
- Experience with Healthcare - Medicare Advantage, preferred
- Experience in developing and managing relationships
- Understanding and experience with hospital, managed care, and provider business models a plus
- Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
- The ability to influence audiences through strong written and verbal communication skills.
- Experience with formal presentations.
- Customer centric and interpersonal skills are required.
- Demonstrates an ability to maneuver effectively in a changing environment.
- Demonstrates problem solving, decision-making, negotiating skills, contract language and financial acumen.
- Proficient with Microsoft Office tools required.
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Provider Contracting Lead Analyst - Franklin, United States - Cigna
Description
Job Description
LOCATION: Supports the Franklin, TN market and will work in the Franklin, TN office several days per week
Medicare Advantage position
The Provider Contracting Lead Analyst serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.
Provides advanced professional input to complex Network Management assignments/projects. Develops and manages the physician/provider network. Develops programs to recruit, service, train, and reimburse physicians and providers. Solicits participation of physicians, hospitals, ancillary, institutional, and other health service providers to establish networks. Responsible for contracting, credentialing, relationships, and services. Serves as a communication link between prospective providers and the organizations. Negotiates contracts to develop networks. Designs and implements programs to maintain positive relationships between the health plan, physician, providers, and practice managers. Has knowledge of contracting process, contract management, network operations, Medicare fee schedules, financial terms, and metrics. Supports and provides direction to more junior professionals. Works autonomously, only requiring "expert" level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Network Operations.
DUTIES AND RESPONSIBILITIES:
POSITION REQUIREMENTS:
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.
Provider Contracting Lead Analyst professionals in Franklin
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Serge Petrenko
Full Stack Software Engineer