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Job Location: Hartford, CT
WORK LOCATION: Georgia – Alabama Market
The Healthcare Provider Data Lead Analyst serves as an integral Provider Data Analytics member of the Local Market Network Management Team. This role assists in developing the strategic direction and management of the alternative access network contracting activities for a given market. The role is focused on configuration of new alternative access networks, maintaining existing alternative access networks and any reconfigurations of existing alternative access networks. This position will be a subject matter expert on the criteria and intent for each alternative access product in the assigned market(s). This position works in close collaboration with Network Development & Competitive Insights, Network Solutions, Network Operations, Pricing, Provider Services, Product, and Compliance.
The position is active in both the evaluation of network design opportunities and the network implementation. The role will not be responsible for loading the network directly, but is responsible for ensuring the Contracting intent is translated correctly to Network Solutions and Network Operations, and that contract interpretation flows consistently to downstream processes. The role will remain active in the ongoing support of the integrity of the alternative networks.
DUTIES AND RESPONSIBILITIES
Subject Matter Expert for all Alternative Access Networks in assigned markets, including inclusion/exclusion criteria, anchor providers, network adequacy and differences between various alternative access products in assigned markets.
Evaluate various network configuration alternatives and make informed recommendations to markets. Includes, in part, acquiring information on multiple scenarios, analyzing, reporting, recommending, compiling, reviewing, and/or submitting data as required to ensure network meets established solution criteria.
Analyze GeoAccess and Quest reporting in multiple scenarios during strategic discussions and then for ongoing network adequacy maintenance.
Works in partnership with Network Solutions to manage the end to end network build, reconfiguration or expansion (i.e. drive the creation of correct provider files based on criteria, analysis, reporting and decision making).
Develop and maintain contract grid to track contracting activities required for implementation, provide Contracting updates on project implementation calls with AAN or Network Operations team
Develop guidebooks, GSI and GMI summaries, and identify criteria logic tools for provider inclusion/exclusion
Translates the intent of the delivery system criteria as it relates to network configuration, works with other areas to resolve discrepancies and ensures that it will be consistently applied across all tools and processes.
Coordinate with matrix partners in Network Solutions and Compliance to ensure appropriate submissions. Coordinates discussion regarding any overlap and variations between products and markets to ensure consistency.
Conducts ongoing evaluation of network criteria to maintain quality control of the network construct. Provides recommendations for issue resolution. Reviews data files for data engineering, check-out quality audits and loading submissions.
Responsible for coordinating market sign off of data loading files during implementation and LocalPlus reconciliation trueups.
As part of end to end implementation management, ensure critical timelines are consistently met. Proactively provide input on maintenance requirements during implementation planning.
Understand Federal and State regulatory requirements, especially as they relate to market suppression, providers accepting new patients, and the requirements for network adequacy, communicating with Compliance to obtain guidance.
Interacts with Compliance to support requirements for filing processes, which may include development, evaluation, formatting and reporting of information to regulatory bodies.
Manage network adequacy reporting analysis and validation processes during the phases of alternative network evaluation, implementation and filing, as well as on an ongoing basis. May assist in annual re-filings, as required, to ensure consistency.
Manages the LocalPlus product reconciliation trueup process for aligned market(s) by running reports, summarizing results, assigning needed research to Provider Services, getting needed approvals from Contracting and submitting for loading/correction.
Ensures that communications are issued on network HCP changes per established processes.
Participates in the development of internal training and documentation updates, as required.
Works closely with Regional and National Network Access Leads. Determine implications and alternatives related to pending terminations impacting alternative access networks.
Manages review of quarterly Network Health reports to ensure Regional Network Analysts are managing necessary recruitment so that all alternate access products remain in compliance according to State and Federal guidelines.
CMS ECP provider review process to support annual Compliance network adequacy and filings for on-market IFP solutions as required.
Provide guidance or expertise to other Provider Data Network Advisors in the local markets. May also provide coverage for other markets as required.
Resolve elevated and complex issues.
Provides reporting and analysis support for the local market Network Management team, as required.
POSITION REQUIREMENTS
Bachelor’s degree required, MBA or MHA preferred
Healthcare Data Analytics experience required
Provider Network Contracting and Provider Relations experience preferred
Experience with Commercial and Government products a plus
Demonstrates understanding of provider data structures, design/implementation/architecture and working with large data sets, Data Integrity and Data Quality
Ability to develop an understanding of market-specific nuances and network constructs
Working knowledge of hospital, managed care, and provider business models
Strong project management, analytical and critical thinking skills
Team player with proven ability to work both independently and collaboratively by developing strong working relationships within a fast paced matrix organization
Strong written and verbal communication skills
Superior problem solving and decision-making skills
Ability to interact and negotiate effectively with various matrix partners
Experience with Cigna Provider Systems: Provider Workbench, Central Provider File, HCPM a plus
Proficient with MS Office including strong Access and Excel skills to support data mining and analysis
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.
For this position, we anticipate offering an annual salary of 72,100 – 120,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .
About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
Cigna 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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