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Company Name:
Cigna
Approximate Salary:
Not Specified
Location:
Phoenix, Arizona
Country:
United States
Industry:
Information Technology
Position type:
Full Time
Experience level:
1-2 Years
Education level:
Bachelor's Degree

ACO Operations Manager

 

Description

This position is responsible for executing the strategy, compliance and optimization of value-based and other payer arrangements with Cigna Medical Group.

MAJOR RESPONSIBILITIES

Lead the development of and execute payer strategies consistent with CMG strategic plan and negotiate professional services contracts with payers, IPAs and government programs.

Optimize payment for quality, shared savings and other value-based terms of payer contracts by advising, consulting and collaborating with clinical operations to align and augment people, processes and technology to value-based arrangements.
Manage outreach coordinators in the execution and achievement of quality parameters specified in accountable care contracts across payers.

Educate Cigna Medical Group staff, physicians and network providers about the terms and conditions of payer contracts and performance improvement opportunities. Ensure that the appropriate level of support and education is provided concerning payment for quality, medical cost and other managed care-related issues; also provides timely in-servicing of new contracts and contract updates.

Work closely with Finance management, responsible for short and long range financial forecasting and related financial planning processes related to contract revenues and performance
Perform a variety of projects related to the analysis of claims, clinical and financial data, with a focus on improving financial performance and health outcomes for managed populations
Monitor payer contract terms and deliverables and ensures that parties are compliant with all standards, terms and conditions
Serves as the primary liaison with all payers.

Participates in external managed care organizations to remain current on industry trends.

 

OPTIMIZATION OF ACCOUTNABLE CARE OPERATIONS PERFORMANCE
Develops and maintain accountable care/value-based reimbursement dashboard to identify performance and opportunities
Manage outreach coordinators in the execution and achievement of quality parameters specified in P4Q programs across payers

Analyzes payer reports and internal population management analytics, financial reports, and other reports to identify revenue opportunities and close performance gaps, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models.
Collaborates with CMG COO to align and enhance clinical operations to optimize or comply with value-based/contract terms.
Lead the preparation of monthly contract performance results and related financial reporting
Work closely with Finance management, responsible for short and long range financial forecasting and related financial planning processes related to contract revenues and performance
Coordinate with the revenue cycle organization to insure that all contracts are entered into the revenue recognition system on a timely basis.

Ensures timely and effective communication to appropriate CMG departments regarding contract updates/renewals
The ongoing management of provider incentive distribution programs, including the periodic reporting of results, annual distribution calculations and budgeting
CONTRACTING STRATEGY & CONRACT COMPLIANCE

Lead the development of and execute payer contract strategies to support the CMG strategic plan.

Ensure contract language review for all applicable payer, governmental or IPA contracts/renewals as renewals are due.
Negotiates rates within pre-established and approved guidelines; modifications to the approved rate guidelines should be discussed with the CFO & President
Completes contract renewals on a timely basis and submits for signature before renewal date
Represents the range of services which are available through physician entities to outside organizations; integrates all new services/technology within current contract rate schedule
Primary responsibility for “Dispute Resolution” hearings and contract arbitration for applicable contracts
Maintain collaborative relationships with contracted payers and develop processes for timely and accurate exchange of data and information
Lead the process of auditing contract settlements and related supporting data to ensure payer reported results are consistent with contractual terms and supporting data
Serves as primary CMG liaison with payers and designated CMG leaders for all JOCs

Qualifications

Summary of Qualifications

 

Bachelor degree required, MBA or MHA degree preferred
Proven ability to negotiate and influence decisions
Strong analytic skills, and the ability to take data and prepare presentations
Project management experience
Excellent verbal and written communication skills; ability to prepare and deliver presentations to executive level decision makers
Prior knowledge of contracts beneficial

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at [email protected]

Primary Location: United States-Arizona-Phoenix
Work Locations: AZ 25500 N Norterra Dr, Bldg B 25500 N Norterra Drive, Bldg B Phoenix 85085
Job: Provider--Network/Data Mgmt
Work at home opportunity (External):No
Schedule: Full-time
Shift: Day Job
Employee Status: Regular
Job Type: Standard
Job Level: Manager of People