Provider Relations Analyst (Finance)
This position serves as an integral member of the Nonpar Provider Contracting Team and reports to the AVP, National Contracting & Nonpar Network Management. Supporting our evolved enterprise strategy, this role is one of the primary department contact(s) for non-par single case agreements.
Summary : Primarily responsible for the department's Daily Trucare report case assignment, claims review and adjustment reporting assistance, and back-up to the department's Intake email and voicemail box, on an as needed basis. Provides high quality service to internal and external partners. Specific responsibilities include, but are not limited to: ability to partner with various groups in resolving complaints and disputes, and ensures compliance with policies and procedures. Assists providers with inquiries into the boxes, on an as needed basis. Facilitates and manages daily TruCare Report and negotiation assignment. Co-manages claims review and adjustments as directed by Provider Relations Sr. Auditor & Analysis Manager. Proven communication skills. Ability to move quickly and navigate a high paced environment. Highly proficient with balancing multiple priorities.
DUTIES AND RESPONSIBILITIES
- Complete daily TruCare report.
- Review and prioritize daily work assignments to the department Provider Network Managers for timely single case agreement negotiation.
- Assist providers with inquiries (email and voicemail), on an as needed basis.
- Single Case Agreement Claims review and adjustment reconciliation.
- Familiarity with Oneview, FACETS, PMHS, ProClaim.
- Supports department-based goals which contribute to the success of the organization.
- Communicate, collaborate, and cooperate with internal and external business partners.
- Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
POSITION REQUIREMENTS
- Healthcare claims, customer/provider relations experience, required.
- Bachelor's degree, preferably in the areas of Finance, Healthcare or Business.
- Team subject matter expert (SME) for all Claims platforms and processing procedures.
- Familiarity with key concepts around the prior authorization process, in-network versus out of network providers, medical service components (i.e. procedure/service codes, modifiers).
- Strong experience in Trucare, ProviderLink, OneView, ICMS, ProClaim, FACETS, and PMHS.
- Proficient in Microsoft Office Tools (Outlook, Access, Excel, Word, Powerpoint, Sharepoint).
- Supports department-based goals which contribute to the success of the organization.
- Communicate, collaborate, and cooperates with internal and external business partners
- Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
- Fosters an environment of innovation and advancement of tools and procedures.
Personal Competencies Required
- Target driven with the ability to multi-task
- Highly analytical and detail oriented
- Strong collaboration and interpersonal skills
- Ability to make sound business decisions
- Ability to operate in a pressurized environment
- Ability to organize and manage multiple time sensitive work items
- Excellent verbal and written communication skills
- Energetic and enthusiastic
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.
For this position, we anticipate offering an hourly rate of 23 - 35 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
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: 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.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
