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Provider Education Lead Analyst - Hybrid- Memphis or Chattanooga, TN- Cigna Healthcare -
Cigna, Memphis
Must Reside in Chattanooga or Memphis area Job Summary: This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational market. The role will be accountable for assigned provider groups reaching risk adjustment related annual metrics. This role will work directly with providers to assist in achieving accurate and complete coding documentation.Provider Data Lead Analysts will be responsible for the most complex provider groups along the engagement continuum within an assigned market. Lead Analyst will be primary contact for provider groups on Risk Adjustment topics at joint operating meetings, quality meetings, etc.Lead analysts may be asked to provide coaching and support to senior analysts, lead representatives, or other team members to achieve Risk Adjustment goals. The role will work under the direction of Risk Adjustment Manager to reach overall operational market goals in conjunction with market matrix partners. The role will provide subject matter expertise to assigned providers and internal matrix partners of Cigna Medicare's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and CPT coding principles and guidelines and use of own discretion to deliver compliant, effective strategies to meet established goals. Core Responsibilities: In partnership with Risk Adjustment Manager, support the training and development of Senior Analysts and Lead Representatives.Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned provider groups (PODs/IPAs).Accountable to complete and accurate review of multi-year diagnosis coding of assigned population.Understands, develops, tracks, monitors, and reports on key program performance metrics for coding initiatives.Work closely with matrix partners to ensure provider office communications are effective and efficient.Review and act on any assigned audit educational opportunities timely and provide primary care or specialty care provider trainings as necessary to educate on audit findings.Analyze data regarding trends or patterns identified in provider office diagnosis coding. Implement provider office education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards.Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data.Develop relationships with clinical providers/staff and communicate coding and documentation guidelines.Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation.Conduct chart reviews for providers and review provider performance.T his is accomplished by doing virtual training sessions, traveling to the individual practices and/or performing side-by-side education.Assists with research, analysis, and response to inquiries from all internal and external audit departments regarding compliance, coding, and inappropriate coding.Provides second level medical record review of external requests for diagnosis code retraction.Attend risk adjustment and quality provider meetings for assigned provider groups to provide updates, recommendations, or education (may occur be before/after normal business hours)Perform the minimum number of coding quality reviews consistent with established departmental goals.Maintain strictest confidentiality based on HIPAA privacy policy.Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, HCPCSAssure compliance by delivering quality services and meeting all contractual, state & federal legal and regulatory requirements.Maintain CEU credits to ensure credentials are kept up to date. Minimum Requirements: Coding certification required through AHIMA or AAPC (at least one of the below): Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Certified Coding Specialist for Providers (CCS-P)Registered Health Information Management Technician (RHIT)5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred.Must be a strong public speaker with excellent written and verbal communication skills and experience effectively delivering subject matter expertise to a large audience.Prior experiences teaching/training others on correct coding guidelines and have the ability to present to large groups of Physicians/Providers .Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines.Excellent understanding of medical terminology, disease process, anatomy, and physiology.Working knowledge of CPT/Evaluation and Management guidelines.Working Knowledge of CMS Risk Adjustment and HCC Coding Process.Strong computer skills (i.e., MS Word, Excel, PowerPoint). Ability to drive within assigned areas or overnight travel for internal or external meetings. Capacity to attend provider meetings day/evening/weekends as needed within assigned areas. These meetings may be virtual or in person as defined by manager/leadership.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: [email protected] for support. Do not email [email protected] 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.
Pharmacy Operations Senior Representative - Accredo
Cigna, Memphis
As a Pharmacy Operations Senior Representative, you will be responsible for the distribution of workload and monitoring of workflow for members of their assigned area to ensure assigned work is completed timely and accurately. Serves as a resource to supervisor and back up to senior technicians and team members. Shift: Monday- Friday, 1:30 PM to 10:00 PM with the flexibility to work Saturdays when needed. What you'll do: Ensure appropriate distribution of workload and workflow for assigned area including scheduling, shifting resources and back filling as needed.Serve as the first line resource for questions/issues from team and senior technicians, in coordination with supervisor; demonstrates leadership qualities.Effectively manages issues impacting performance and productivity of team members; including documenting issues, offering solutions, collaborating with others, communicating status and escalating as needed.Assist Supervisor in ensuring that established policies and standard operating procedures are being followed and that individual and team goals for productivity and quality are met/exceeded.Assist in the development, documentation and updating of policies and procedures for staff, including specific training and validation material.Assist in training staff regarding procedures, including one on one training and/or to group sessions as needed.Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.Ensure that all team members are cross trained to cover production functions.Other duties as assigned. What you need to do the job: Three to five year's relevant working experience; experience in a pharmacy dispensing setting is required.High School Diploma or equivalent.General PC knowledge: Ability to interpret and create spreadsheets via Microsoft ExcelKnowledge of standard concepts, practices, and procedures within dispensing pharmacyGeneral warehouse, inventory control, and Warehouse Management System experience a plus.Strong attention to detail with good organizational skillsGood verbal and written communication skillsAbility to stand for extended periods of time.Willingness to work a flexible schedule to accommodate heavy work volumes.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 Evernorth Health ServicesEvernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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: [email protected] for support. Do not email [email protected] 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.
Staff Pharmacist Manager - Accredo - Memphis, TN
Cigna, Memphis
This role is onsite at our office in Memphis, TN. This role is worksite dependent and can only be performed onsite. The shift for this position is an evening shift Monday through Friday 1:30 pm- 10 pm. This also includes a Saturday rotation every 5-weeks from 4 am - 12 pm. When working the Saturday rotation, you would have off the Friday before. POSITION SUMMARYThe Pharmacist Manager is responsible for the managing the day to day operations of a team of Pharmacists and Technicians. Day to day operations include fulfillment/dispensing of specialty medication and related ancillary supplies. Monitors productivity and performance standards, plans and directs work flow and project assignments. Oversees production volume to ensure service standards are met. Identifies and assists in resolving recurring issues impacting team key metrics. Provides input and recommendations for performance management and employee development. Conducts hiring, training and evaluation of staff. Responsible for team's adherence to corporate attendance and employment policies. Recognizes and recommends operational improvements.ESSENTIAL FUNCTIONSManage day to day prescription dispensing in the fulfillment center.Schedule and monitor staff and day to day workflow. Develop employee's skills, evaluate performance and provide feedback. Oversees resolution of employee relations. Conducts hiring, training and evaluation of staff.Develop, track and monitor employee's compliance to quality, service and production standards.Monitor prescription turnaround time so that internal standards and client performance guarantees are met. Assist Senior Pharmacy Manager in monitoring costs to ensure compliance with cost to fill goals. Address staff concerns and day to day operational, system, customer service, quality and professional issues. Work in production as needed.Serve as a point of escalation for issues requiring a higher degree of expertise or discretion to resolve. Represents pharmacy operations in cross-functional meetings and projects.Other special projects and tasks as assigned.QUALIFICATIONSB.S or Pharm. D. in Pharmacy3-5 years relevant experienceHome Infusion/Specialty Pharmacy experience preferredPharmacist License in good standing in the state in which the facility is locatedPC skills including proficiency in Microsoft officeGood organizational ability; Strong attention to detail; Ability to work in fast-paced production environment; willingness to work a flexible schedule based on business needs.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 Evernorth Health ServicesEvernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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: [email protected] for support. Do not email [email protected] 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.