This individual reports directly to the Network Operations Manager and will develop and maintain positive relationships with providers and other provider types within the provider network. Will also support the activities of the Network Operations Department, including: drafting provider agreements, assisting and supporting the contractual and operational relationship with providers, coordinating provider data bases, credentialing, resolution of claims and appeals; assisting with the analysis of medical cost trends for providers.
Contracting and Credentialing Support
- Assist in coordinating provider agreements, amendments, and letters of agreement with non-contracted providers as needed by manager and or director
- Ensure copies of executed contracts or correspondence are filed appropriately and returned to providers
- Prepare contract packages, agreements and amendments for mailing to potential providers
- Coordinate, track and ensure credentialing process is complete for providers
- Maintain provider file folders in master files and online databases
- Coordinate Load Forms and Maintain Provider Databases
- Complete and maintain provider rosters reflecting accurate demographic information
- Complete and load contract changes and rate terms for providers in QNXT
- Complete and load providers who submit network interest forms in OnBase
- Assist in coordination of collection, compilation, and maintenance of data for HSD tables for internal, state, and CMS audits as well as any GEO Access Mapping.
- Auditing of rate and demographic data to ensure system accuracy
Provider Orientations and Operational Meetings
- Organizes and conducts operating committee meetings with providers/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities
- Gather operational concerns expressed at operational meetings and work with Administrator or Director to resolve any operational issues
- Initiates and maintains effective channels of communication with providers, office staff and matrix partners
Resolution of Claims and Operational issues with Providers
- Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve escalated and sensitive issues
- Research and investigate provider concerns regarding claims payment, appeals, and resolution of operational issues. Coordinate with Claims Department to research and resolve provider concerns
- Respond to provider questions, phone calls, and inquiries in a timely fashion
Analyze Cost Reporting for Providers
- Assist in the analysis of monthly cost trends for the direct market
- Analyze, prepare and review trend reports and detail by region for monthly presentations
- Recommend solutions and assist in identifying action plans to remediate provider medical cost trends
Other Duties and Responsibilities
- Participate in regularly scheduled meetings with other departments; offer substantive feedback to questions and research thoroughly any unknown issues
- Be available during working hours to coworkers and others for questions; including multi-tasking on calls and other similar scenarios
- Other duties and responsibilities as assigned. While this job description is intended to be an accurate reflection of the duties involved in this position, the company reserves the right to add, remove or alter duties when business need dictates.
- 1-2 year of work experience required
- Bachelor's Degree Preferred
- Presentation, communication and customer service skills required
- Excellent time management and relational skills
- Demonstrated analytical skills
- Strong organizational abilities with attention to detail.
- Computer Skills: Microsoft Word, Excel, PowerPoint
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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.