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Network Operations Representative- Work from home, Western PA at Cigna in Pittsburgh, Pennsylvania

Posted in General Business 30+ days ago.

Type: Full-Time





Job Description:

Remote, work from home - Pittsburgh or Western, PA (must live in/or near area)

Summary

This individual reports directly to the Network Operations management team. They will serve as a primary contact for assigned providers and provider staff to assist in contract management, driving increased provider engagement and provide supporting analyses for network and performance optimization. Develops and maintains positive relationships with providers and other cross-functional, cross-collaborative team including Network Operations, Sales, Health Services, Coding, Finance, Marketing, Stars, Centers of Excellence (COE), and Commercial Contracting. This role supports the activities of the Medicare Network Operations Department.

Responsibilities


  • Responsible for the strategy and execution of stars, coding, and unit cost performance of assigned territory.

  • Responsible for creation and delivery materials to educate providers and provider staff on policies and procedures, contracting, quality, coding, service line initiatives and financial performance efficiencies.

  • Organizes and conducts operating committee meetings with provider/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities

  • Initiates and maintains effective channels of communication with providers, office staff and matrix partners

  • Assist in analysis of monthly cost trends for the direct market, including recommending solutions and assist in identifying action plans to remediate provider medical cost trends.

  • Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding and Stars/quality performance; support coding and stars initiatives through network operations initiatives and contract negotiations.

  • Conduct internal audits for provider accuracy and work with network operations team to obtain rosters

  • Monitor the Network Interest Committee intake boxes for providers/groups seeking participation in the Ohio Medicare network and updating excel for contracting team. As needed working with provider groups in standard contracting process

  • Serving as a point of contact for roster management, accuracy of provider data loading, and main contact for Provider Data Loading team

  • Must learn to navigate internal systems for data: QNXT, Online Provider Directory (OLPD), Tract Manager, OnBase, QUEST and ART

  • Conduct internal audits for provider roster accuracy and work with network operations team to obtain rosters

  • Perform special projects and other duties assigned by leadership.


  • Coverage Area: Western, PA

  • Car and valid driver's license required- mileage reimbursement provided

  • This role may require 50% or more of local travel to providers.

Qualifications:


  • High School Diploma or GED required, college degree, preferred

  • Work experience of 2 or more years in Medicare based or Medicare Advantage, preferred

  • Ability and willingness to share knowledge as well as train, develop, and coach individuals with varying levels of experience.

  • Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).

  • Act with a sense of urgency to research questions or issues brought by the team. Identify the right parties or resources to resolve these issues. Follow up with these parties to drive resolution and provide on-going feedback to individual(s) who raised the question or issue.

  • Positive role model and have the ability to work independently and in conjunction with co-workers of all levels.

  • Strong negotiation, presentation, analytical and problem-solving skills.

  • Excellent communication skills - verbal, written and presentation.

  • Working knowledge of Microsoft Office. Ability to quickly learn and master basic contracting platforms and databases.

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

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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