Network Adequacy and Data Analyst - MidAtlantic Region (Finance)

WORK LOCATION: Richmond or McLean, VA

Hybrid position - will require 3 days in the office

GENERAL DESCRIPTION

This position serves as an integral member of the Field Contracting Team. This role is primarily responsible for monitoring and reporting on the network adequacy for the assigned market(s). This role also assists in developing the strategic direction and management of the alternative access product contracting activities for a given territory, including the configuration of new alternative access networks, maintaining existing alternative access networks and any reconfigurations of existing alternative access networks. This position will be a subject matter expert on network adequacy as well as the criteria and intent for each alternative access product in the assigned market(s). This position works in close collaboration with Compliance and Regulatory Reporting, Network Development & Competitive Insights, Network Solutions, Network Operations, Medical Economics, Provider Services, and Product.

The position is active in both the evaluation of network adequacy and provider recruitment opportunities. The role is also actively involved in network design opportunities and the network implementation / expansion. The role will not be responsible for loading the network directly, but is responsible for ensuring the Contracting intent is translated correctly to Network Solutions and Network Operations, and ensuring that contract interpretation flows consistently to downstream processes.

DUTIES AND RESPONSIBILITIES

• Manage network adequacy reporting analysis and validation processes during the phases of State filings as well as alternative network evaluation, implementation and filing. Responsible for monitoring network adequacy on an ongoing basis. Actively participate in annual State re-filings, as required, to ensure consistency.
• Subject Matter Expert for all Alternative Access Products in assigned markets, including inclusion/exclusion criteria, anchor providers, network adequacy and differences between various alternative access products in assigned markets.
• Evaluate various network configuration alternatives and make informed recommendations to markets. Includes, in part, acquiring information, analyzing, reporting, recommending, compiling, reviewing, and/or submitting data as required to ensure network meets established solution criteria.
• Works in partnership with Network Solutions to manage the end to end network build, reconfiguration or expansion (i.e. drive the creation of correct provider files based on criteria, analysis, reporting and decision making).
• Represent Contracting for updates and decision making for items delegated by the market
• Translates the intent of the delivery system criteria as it relates to network configuration, works with other areas to resolve discrepancies and ensures that it will be consistently applied across all tools and processes.
• Coordinate with matrix partners in Network Solutions and Compliance to ensure appropriate submissions. Coordinates discussion regarding any overlap and variations between products and markets to ensure consistency.
• Conducts ongoing evaluation of network criteria to maintain quality control of the network construct. Provides recommendations for issue resolution.
• Responsible for coordinating market sign off of data loading files during product and network implementation.
• As part of end to end implementation management, ensure critical timelines are consistently met. Proactively provide input on maintenance requirements during implementation planning.
• Understand Federal and State regulatory requirements, especially as they relate to market suppression, providers accepting new patients, and the requirements for network adequacy, communicating with Compliance to obtain guidance.
• Interacts with Compliance to support requirements for filing processes, which may include development, evaluation, formatting and reporting of information to regulatory bodies.
• Manages the LocalPlus product data validation and clean-up process for aligned market(s) by running reports, summarizing results, assigning needed research to Provider Services, getting needed approvals from Contracting and submitting for loading/correction.
• Proactively provide feedback to National Network Access Lead on issues, training, areas of confusion, inconsistencies and recommendations related to the role
• Ensures that communications are issued on network HCP changes per established processes.
• Participates in the development of internal training and documentation updates, as required.
• Works collaboratively with resources within the region, other regions and nationally to ensure projects are consistently tracked and reported, as required.
• Works closely with Regional and National Network Access Leads. Determine implications and alternatives related to pending terminations impacting alternative access networks.
• Manages review of quarterly Network Health reports to ensure Regional Network Analysts are managing necessary provider recruitment so that all alternate access products remain in compliance according to State and Federal guidelines.
• Responsible for CMS Essential Community Provider (ECP) review process to support Compliance network adequacy and filings for on-market IFP solutions.
• Provide guidance or expertise to other Network Operations Advisors. May also provide coverage for other markets, as required.
• Resolve elevated and complex issues.
• Provides reporting and analysis support, as required.

POSITION REQUIREMENTS

• Bachelor's degree or equivalent work experience; MBA or MHA preferred.
• 2+ years of Provider Network knowledge/experience required. Provider Contracting and Provider Relations experience preferred.
• 2+ years of Data Analytics experience required.
• Cigna provider systems experience preferred.
• Strong project management, analytical and critical thinking skills.
• Team player with proven ability to work both independently and collaboratively by developing strong working relationships within a fast paced matrix organization.
• Working knowledge of hospital, managed care, and provider business models.
• Strong Data Analytics and/or Financial Economics skills to support data mining and analysis.
• Proficiency in Microsoft Excel required; Microsoft Access skills a plus.
• Experience with health care Commercial and IFP products a plus
• Strong written and verbal communication skills.
• Superior problem solving and decision-making skills.
• Ability to interact and negotiate effectively with various matrix partners.
• Demonstrates understanding of provider data structures.
• Ability to develop an understanding of market-specific nuances and network constructs.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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 reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.