The Payer Contract Analyst (PCA) is responsible for proper contracting and revenue cycle management support. Ensures contracting requirements are met and provides analysis, problem resolution, auditing, reporting and process recommendations for optimal outcomes. The PCA will assist Contracting with contacting payers to receive relevant information for billing. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills.
What you’ll do to make a difference:
- Assist RCM team with escalated systemic billing/collection issues.
- Assist with network contracting by making calls to payors, follow-up support and documentation requirements.
- Supports the payer contract team ensuring that contract requirements are appropriately met, contracts are kept up-to-date in the pharmacy electronic files. Assists in payer negotiation activities.
- Monitors performance of the payer process to ensure correct policy and procedures are being followed.
- Acts as the subject matter expert in the requirements, rules and regulations of third-party and government payers. Understands eligibility requirements and authorization requirements of insurance company plans, Medicare, and Medicaid, and how each program/payer reimburses.
- Assist Payer Contracting team with updating Contract folders as well as completing contract cover sheets and other special projects as required.
- Manages defined processes to ensure effectiveness and efficiency in the process and maintains databases, including contract/fee schedule rate updates, to ensure proper tracking, audits, reporting, analysis and resolution occurs timely and appropriately.
- Assist Revenue Cycle Analyst by assuming some of the regularly scheduled reports; assist in meetings to design newly requested reports as required by the Revenue Cycle Department.
- Assist with drug profitability requests.
- Ensure accurate and timely completion of all assigned and projects.
- Other duties as assigned.
What you need to be successful:
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- Knowledge of reimbursement practice and electronic claims processing is preferred.
- Preferred experience in pharmacy and health insurance where the work performed required a basic knowledge of contracts, third party insurance, HIPAA, and governmental payment knowledge of Medicare and Medicaid.
- Strong knowledge of payor contracting and managed care programs
- Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
- Attention to detail is critical to the success of this position.
- Must be able to manage multiple projects simultaneously.
- Must be willing and able to work independently or in a collaborative setting, based on project need.
- Must be able to communicate effectively.
- Discretion in handling confidential company information.
- Ability to effectively approach problem solving.
- Proficiency in MS Office software, Excel and Power BI experience preferred.
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.
For this position, we anticipate offering an hourly rate of 24 - 40 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
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