Network Operations Coordinator/Data Analyst- Express Scripts

Network Operations Project Coordinator/Data Analyst-Express Scripts

(Network Operations Advisor)

Position Summary

This position within the provider validations team is responsible for translating network compliance processes into evolving business requirements that will further progress technology solutions, assisting with credentialing, compliance, and operations feature prioritization, and understanding any analytical needs across the Network Compliance organization. This role will also consult with members of the team to identify opportunities to leverage existing data sources and develop reporting that will allow the team to more efficiently and accurately perform standard tasks, as well as bring new insights to assist with decision-making and process improvement. This role will have responsibility to develop network products, reports, and strategy designed to drive margin initiatives as well as anticipate and meet client needs supporting audit, reporting, and operational process/tool developments. Finally, the role will also focus on improved service to providers through innovative communication and technology functions.

Duties and Responsibilities

• Responsible for partnering with the Network Compliance leadership team to transform business operations and process improvements into technology requirements to gain efficiencies within system applications and advance automation efforts
• Coordinate or participate in cross functional/departmental collaboration with other internal teams, including but not limited to, Network Compliance, Retail Network Operations, Retail Strategy and Contracting, the Pharmacy Special Investigations Unit, and Sales and Account Management in order to develop solutions for strategic business needs
• Generate credentialing, recredentialing and compliance reports as needed for specific clients to support contractual commitments and compliance audits
• Identify and act upon opportunities to enhance the provider onboarding and recredentialing experience by creating solutions to improve team timeliness, efficiency, accuracy, and service.
• Recognize opportunities to improve on existing communication pathways to support providers through the credentialing and network compliance processes
• Perform ad hoc analyses and special projects, when needed
• Research best practices and improvements involving analytics, tools, and process improvement
• Provide support for questions and issues raised by teammates and internal network partners. Provide answers as quickly as possible, supporting the timeliness of the review or outreach.

Qualifications

• Bachelor's degree preferred; HS Diploma required
• Knowledge of pharmacy provider networks, contracting and credentialing requirements, network systems, and terminology
• Pharmacy benefit management experience preferred, including familiarity with the regulatory environment and compliance issues (i.e., URAC accreditation maintenance, credentialing, delegation and oversight standards, etc.)
• At least 1 year of experience working with relational databases
• Proficient both at developing new and modifying existing SQL code
• Strong analytical, planning, problem identification and resolution skills required
• Project management skills: liaison for the team to the Business Project Owner, coordinate testing plans/scenarios, gather requirements and documents, aid team in meeting project deliverables
• Ability to work in a fast-paced environment and multi-task across multiple deadlines and deliverables, often under uncertain or ambiguous circumstances
• Excellent communication, organizational, and time management skills essential
• Comfortable communicating concerns, questions, and risk at all levels of the organization
• Consistently maintain a positive, helpful, engaged attitude
• Self-starter that can independently support and resolve issues and conflicts with minimal management oversight
• Microsoft Office - Advanced Excel skills, including experience with formulas, data analysis, and/or pivot tables; fluent with PowerPoint, Word, etc.

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 Services

Evernorth 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.