Payer Contract Analyst

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🕒 4 days ago

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Support the revenue cycle management team with escalated systemic billing and collection issues • Assist network contracting through payer calls, follow-up support, and documentation • Maintain payer contract requirements and update pharmacy electronic files • Assist with payer negotiation activities • Respond to questions about contracts, reimbursement, benefit design, and contracted services • Monitor payer processes for compliance with policies and procedures • Provide subject matter expertise on third-party and government payer requirements, rules, and regulations • Understand eligibility and authorization requirements for insurance plans, Medicare, and Medicaid • Update contract folders and complete contract cover sheets and special projects • Manage processes and databases, including contract and fee schedule rate updates, for tracking, audits, reporting, analysis, and timely resolution • Assume regularly scheduled revenue cycle reports and assist in designing new reports • Assist with drug profitability requests • Complete assigned work and projects accurately and timely • Perform other duties as assigned

🎯 Requirements

• High school diploma or GED required • 3+ years of Home Infusion experience required • Knowledge of reimbursement practices and electronic claims processing • Preferred pharmacy and health insurance experience • Basic knowledge of contracts, third-party insurance, HIPAA, Medicare, and Medicaid • Strong knowledge of payer contracting and managed care programs • Strong experience with reporting, Excel, BI, and data flows • Excellent interpersonal, organizational, communication, and problem-solving skills • Strong attention to detail • Ability to manage multiple projects simultaneously • Ability to work independently or collaboratively as needed • Ability to communicate effectively • Discretion in handling confidential company information • Proficiency in Microsoft Office software • Power BI experience preferred • For home working, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Cable broadband or fiber optic internet service requirement for home working