CareAllies Network Ops Senior Analyst - Hybrid: Huntsville, AL - Cigna Healthcare
About the position
The CareAllies Network Ops Senior Analyst position at Cigna Healthcare is a pivotal role within the Provider Engagement Team, focusing on enhancing the quality and value of care provided to patients. This position is integral to the CareAllies subdivision, which collaborates closely with healthcare providers and payer entities to improve patient care experiences. The analyst will work directly with providers to facilitate their transition to value-based care, ensuring they can effectively manage the long-term health of their patients. The consultative approach of CareAllies emphasizes the importance of physician engagement, organizational culture change, actionable data analytics, and patient engagement to support effective treatment plans. The analyst will play a crucial role in driving change and ensuring success in a value-based healthcare market. In this role, the analyst will serve as the primary contact for providers and their staff, assisting in contract management and providing analytical support for network and performance optimization. Building and maintaining positive relationships with physicians, providers, and practice managers is essential, as is overseeing and managing performance in various incentive-based and value-based programs. The analyst will provide tactical operations support, which includes contracting, data integrity, communications, and relationship management. Additionally, the analyst will create and deliver educational materials to providers and their staff regarding contracts, policies, quality initiatives, and financial performance. The position also involves preparing and delivering presentations during monthly operational meetings with providers and physician leadership. The analyst will track, monitor, and report on key program performance metrics, such as utilization, coding, and quality performance indicators like STARs. Conducting root cause analyses related to provider concerns, grievances, claims, and care delivery will be part of the responsibilities, as well as assisting in data collection for STARS and clinical metrics, and designing plans for enhanced provider engagement in quality initiatives. The analyst will also prepare materials for and participate in monthly financial reviews with senior leadership, collaborating with various internal departments to develop solutions for strategic business needs.
Responsibilities
?? Serve as primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization.
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?? Develop and maintain positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs.
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?? Provide tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management.
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?? Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance.
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?? Prepare and deliver presentations with providers, provider staff, and/or physician leadership during monthly operational meetings.
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?? Understand, develop, track, monitor and report on key program performance metrics, such as utilization, coding, and STARs/quality performance.
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?? Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery.
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?? Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives.
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?? Prepare materials and participate in monthly financial review with senior leadership.
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?? Partner with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs.
Requirements
?? Bachelor's Degree in Healthcare Administration, Business, Finance, Operations, Public Health, or Professional Sales or equivalent experience.
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?? Solid understanding of health insurance, customer messaging/design and project management required.
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?? Excellent communication skills - verbal, written and presentation.
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?? Experience in public speaking is a plus.
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?? Intermediate level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.).
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?? Experience in financial/trend analysis preferred.
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?? Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.
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?? Creative thinker with ability to think outside the box and translate ideas into actions.
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?? Strong problem solving skills.
Nice-to-haves
?? Experience in public speaking is a plus.
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?? Intermediate level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.).
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?? Experience in financial/trend analysis preferred.
Benefits
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