Network Operations Senior Analyst

Cigna Bedford , TX 76021

Posted 2 months ago

Job Summary:

Develops and maintains positive relationships with Skilled Nursing and Custodial Nursing Facilities within the provider network.

Core Responsibilities:

  • Educating providers and office staff on contracts, policies, and procedures

  • Managing the contracting process

  • Root cause analysis and resolution of problems and issues

  • Managing monthly provider visits and calendar of event

  • Develop, maintain, and distribute incentive reports to facilities

  • Participate in meetings with facility's staff, and/or leadership, and plan, create and deliver presentations

  • Perform quality checks on provider communication material

  • Requires at least 30% external travel to network providers

  • May provide guidance to others in the department

  • This is a Work at Home position tied to McAllen, Tyler or Bedford, TX location

Minimum Qualifications:

  • Ability to travel up to 30% (most travel will be local to the McAllen, Tyler or Bedford, TX locations)

  • High School Diploma or equivalent is required

  • Minimum 2-3 years of customer service claims, and/or payor related experience

  • Proficient in Microsoft Office products and learning reporting applications

  • Excellent communication skills

Preferred:

  • Bachelor's Degree

  • Minimum three years' experience in physician relations or Managed Care for Medicaid

  • Demonstrated knowledge of contracting process, Medicaid fee schedules, financial terms, and metrics

  • Proficient in Nursing Facility billing and able to resolve billing/payment inquiries

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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 an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Medical Affairs Operations

Ocular Therapeutix

Posted 5 days ago

VIEW JOBS 3/24/2020 12:00:00 AM 2020-06-22T00:00 Overview The Medical Affairs Operations role will be an integral part of the Medical Affairs team. S/he will be accountable for executing logistical and operational tasks critical for cross-functional and department activities, including management of contracts, purchase orders and budget spend. S/he will manage the training materials for internal and external stakeholders, in partnership with Medical Communications. In addition, S/he will be responsible for team organization at conferences of all sizes, providing administrative support and assistance as needed. S/he will serve as the medical signatory on medical review of materials for promotional materials and non-promotional materials. This individual liaises with a variety of stakeholders across functions and is responsible for managing project deadlines and ensuring high quality documents are available for distribution to support the Medical Affairs team. Responsibilities Leadership and Strategy * Submit and maintain Business Needs Forms for all relevant activities * Organize contract execution for Healthcare Professionals, including Contract Approval, collection of supporting documentation, and Fair Market Value assessment * Complete payment (check requests) for vendors; track payments against operating expenses * Organize contract execution for vendor partners; process invoices and track payments against operating expenses * Maintain purchase orders * Document and process received goods and service invoices for Medical Affairs department * Provides logistical support for Trainings, advisory boards, and other meetings (internal and external) * Act as point person responsible for coordinating ordering and shipment of product and equipment to approved investigator-initiated trials, medical grant recipients, field MSL team requests as well as management of loaned resources including management of return shipping. * Prepare internal/external training documents/binders, other correspondence and documents as needed Medical Community Engagement * Logistical conference planning for national, regional, and local conferences * Manage materials and ensure all required and approved content is available for dissemination, in partnership with Medical Communications * Book and maintain reservations for meals, rooms, and other Knowledge Management * Serve as the medical signatory for promotional, and non-promotional materials on the Internal Review Committee ensuring accuracy, relevance and completeness, of scientific data and associated references * Ensure internal document and information repository is maintained and accessible for Medical Affairs stakeholders * Support the development of training materials for Medical Affairs stakeholders based on scientific communications platform * Develop and maintain current, broad, and in-depth knowledge of pathophysiology, pharmacotherapy, and clinical outcomes associated with products and relevant disease states * Maintain and track Data on File * Maintain reference library, bibliographies and eLibrary subscriptions (via RightFind management or other document management system) * Organize and maintain references related to SCP and publications, including Data on File Cross-Functional Collaboration * Support the execution of congress plans and MSL activities in collaboration with other internal functions * Provide updates to internal stakeholders on related activities Other * Demonstrate the values of Ocular Therapeutix * Other duties as assigned Supervisory Responsibilities: May oversee the work of external consultant(s) and/or manage vendor(s) Qualifications * Bachelor's degree with related health science background preferred * Experience in the ophthalmic pharmaceutical space preferred, but not required * 1+ years' experience in Medical Affairs or related fields like medical device, biotech, pharma or others * Exceptional project management, superior organizational and advanced MS Office skills required (Word, Excel, PowerPoint) * Experience with Veeva Vault Promo mats preferred but not required * Excellent verbal and written communication skills (including meticulous proofreading) * Team-oriented, flexible, creative, inquisitive, driven and extremely reliable * Ability to learn applications quickly * Excellent verbal & written communication skills * Support/back up internal medical affairs team * Ability to work with and collaborate will all levels and groups * Ability to travel 15% Ocular Therapeutix Bedford TX

Network Operations Senior Analyst

Cigna