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Provider Relations Representative - Medicare Advantage (Work Location - Maricopa County), Phoenix, Arizona

Created04/07/2021
Reference21005532
CategoryOperations
Job typeFull Time
CountryUnited States
StateArizona
CityPhoenix
Zip85001
SalaryCompetitive
SUMMARY:

Our Provider Relations Representative will provide broad support to Providers, Manager, Director, and Other Administrators. This position is exposed to all aspects of a Coordinated Care Organization (financial understanding, provider network building, conflict/issue resolution, contracting, claim payment, meetings, training, etc.). The Network Operations department is responsible for the financial and operational activities of Provider networks and this position involves extensive interaction with the Network Operations staff as well as other Cigna Medicare departments.
  • Coverage Area - Maricopa County
  • Field work - approximately 3 days weekly, local travel (Position requires that the time be spent primarily externally with administrative support).
  • Position will be based out of Cigna Norterra location
  • Reliable transportation and valid driver's license
  • Mileage reimbursement provided


RESPONSIBILITIES:
  • Educating providers and office staff on health plan initiatives, contracts, policies, and procedures.
  • Managing monthly communications and face to face provider visits and calendar of events.
  • Maintain contracted provider demographic records by validating and submitting all data management requests for completion.
  • Prepare for and participate in meetings with providers, provider staff, and/or physician leadership.
  • Manage joint operations committee (JOC) meetings. This includes: formulating meeting agenda, and recording minutes from meeting.
  • Planning, creating, and delivering presentations.
  • Partners with other internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop solutions for strategic business needs.
  • Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding, and STARs/quality performance
  • Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives
  • Perform financial analysis & participate in market financial review with senior management.
  • Trouble shoot claims issues for providers
  • Investigate member grievances within network.
  • Attend various meetings and assist with facilitation
  • Misc.-Administrative Responsibilities


REQUIREMENTS
  • High School Diploma or equivalent required, Bachelor's degree, preferred
  • Minimum one year customer service claims, and/or payor related experience
  • Proficient in Microsoft Office products and learning reporting applications
  • Strong analytical and problem solving skills
  • Ability to prioritize and multitask
  • Excellent verbal and written communication skills
  • Two or more years' experience in physician relations or Managed Care for Medicaid, preferred
  • Demonstrated knowledge of contracting process, provider relations, Medicaid fee schedules, financial terms, and metrics, preferred


About Cigna

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.
Employer702 CIGNA HealthCare of AZ, Inc.

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