Payer Contract Analyst

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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, 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 contract questions regarding 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 eligibility and authorization requirements for insurance plans, Medicare, and Medicaid, including reimbursement methods • Update contract folders and complete contract cover sheets and special projects • Manage defined processes and maintain contract and fee-schedule databases for tracking, audits, reporting, analysis, and timely resolution • Assist with scheduled revenue cycle reports and development of newly requested reports • Assist with drug profitability requests • Complete assigned duties and projects accurately and timely • Perform other duties as assigned

🎯 Requirements

• High school diploma or GED required • 5+ years of Home Infusion experience required • Knowledge of reimbursement practices and electronic claims processing • Preferred pharmacy and health insurance experience involving contracts, third-party insurance, HIPAA, Medicare, and Medicaid • Strong knowledge of payer contracting and managed care programs required • Strong experience with reporting, 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 as project needs require • Ability to communicate effectively • Discretion when handling confidential company information • Ability to approach problem-solving effectively • Proficiency in MS Office software • Excel and Power BI experience preferred

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • 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 requirement with at least 10Mbps download/5Mbps upload for home working