Medicare Provider Terminations Lead Analyst - Cigna Healthcare - Remote at Cigna in Bloomfield, Connecticut

Job Description:

POSITION OVERVIEW

The Medicare Terminations Management team ensures consistent and compliant execution of Medicare provider terminations and coordination of efforts to retain members impacted by terms. This position role is responsible for contributing to the development and managing the provider terminations process. In collaboration with internal matrix partners and a small team, they will enable the intake, assessment and processing of Provider Terminations, development and tracking of key performance indicators and help to ensure the efficient and compliant completion of the termination workflow. Manages the hospital/large group and/or significant provider termination management process in assigned markets for Medicare Advantage products. Works closely with Contracting, Network Solutions, Network Operations, Provider Services, Sales and Compliance to meet termination process management guidelines/state requirements.

RESPONSIBILITIES

• Facilitate termination meetings for one of the three regional termination management weekly calls for pending termination process for status and updates inclusive of all stakeholders. Distributes notes and deliverable communication timelines.


• Manage the creation and distribution of the weekly term management workgroup meetings.


• Create and submit network change alerts for posting to Cigna's internal tool, Knowledge Xchange, to communicate external notifications and changes for active potential hospital/large group or significant terminations.


• Responsible for disruption reporting tracking and development on all Significant Terminations.


• Works closely with Contracting, Network Solutions, Network Operations, Provider Services, Sales, Retention team, Health Services & Case Management and Compliance to meet termination process management guidelines/state requirements.


• Strive to become the subject matter expert (SME) for Significant and Non-Significant Termination processes.


• Work collaboratively with resources within the region, other regions and nationally to ensure projects are consistently managed, tracked and reported for terminations


• Initiate and collaborate with NORM team to request all disruption reporting for termination process. Track and


• Create mailing list, verify/audit data received from NORM to ensure accuracy for required data requested and needed for mailing list.


• Work closely with compliance to ensure all regulatory compliance needs/request are completed. Key contact for compliance for all Significant Terminations Network Fact Sheet submissions to CMS.


• Develop a deep understanding of the provider terminations workflow and accomplish the completion of provider terminations that enter the workflow


• Triage, route and/or complete provider terminations that enter the workflow from beginning to end, tracking its progress and assisting with any unique circumstances that delay its processing


• Identify gaps and areas of improvement in the provider terminations workflow and work with team and matrix partners to solve


• Help support the creation of the tools, templates, playbooks, and training required to efficiently process provider terminations


• Participate in the development of future process development that will enable more automated processing, higher levels of efficiency and coordinated workflows.


• Own SharePoint site updates, organization of files, tracking and tools utilized for termination process.


• Work closely with Termination Management Senior Manager on process development and projects.


• Special projects as required.

REQUIREMENTS

• Bachelor's degree highly preferred


• Network Operations experience preferred


• Healthcare experience preferred, Medicare Knowledge Encouraged


• Proficient using Microsoft Office suite products


• Excellent presentation and strong organizational skills required


• Excellent time management and relational skills


• Demonstrated analytical skills


• Ability to collaborate in a highly matrixed environment


• Demonstrated ability to create templates and documentation to support standardization of operations


• Experience mentoring and/or training others

KEY PERFORMANCE INDICATORS:

• Success will be measured by compliant handling of provider terminations entering Term Mgmt Team (time-in to completion, (days)) and accurate description and count of inputs (categorize provider termination type).

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 67,400 - 112,400 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 Group .

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: 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.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.