Payer Contract Analyst

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🕒 5 days ago

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Support the Revenue Cycle Management team with escalated systemic billing and collection issues • Support network contracting through payer calls, follow-up, and documentation • Ensure payer contract requirements are met and contracts remain up to date in 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 • Serve as subject matter expert on third-party and government payer requirements, rules, and regulations • Understand insurance eligibility and authorization requirements, including Medicare and Medicaid reimbursement • Update contract folders and complete contract cover sheets and special projects • Maintain contract and fee schedule databases for tracking, audits, reporting, analysis, and timely resolution • Assume regularly scheduled Revenue Cycle Analyst reports and assist with designing new reports • Assist with drug profitability requests • Complete all assigned projects accurately and on time • Perform other duties as assigned

🎯 Requirements

• High school diploma or GED required • 5+ years of Home Infusion experience required • Knowledge of reimbursement practice and electronic claims processing • Preferred pharmacy and health insurance experience involving contracts, third-party insurance, HIPAA, Medicare, and Medicaid • Strong knowledge of payor contracting and managed care programs required • Strong reporting experience with Excel, BI, and Data Flows required • Excellent interpersonal, organizational, communication, and problem-solving skills • Strong attention to detail • Ability to manage multiple projects simultaneously • Ability to work independently or collaboratively based on project needs • Effective communication skills • Discretion in handling confidential company information • Ability to approach problem solving effectively • Proficiency in Microsoft Office software • Excel and Power BI experience preferred • For home work, cable broadband or fiber optic internet connection with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits starting on day one • Vision benefits starting on day one • Dental benefits starting on day one • Well-being and behavioral health programs starting on day one • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement