Medicare Advantage Specialty Provider Relations Representative

Cigna Tucson , AZ 85704

Posted 2 weeks ago

It's fun to work in a company where people truly BELIEVE in what they are doing!

We're committed to bringing passion and customer focus to the business.

SUMMARY:Network Operations Sr. Analyst provides broad support to Manager, Director, and Other Administrators. Network Operations is responsible for the financial and operational activities of provider networks and this position involves extensive interaction with Network Operations staff as well as other Cigna-HealthSpring departments. 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.).RESPONSIBILITIES:

  • Educating providers and office staff on contracts, policies, and procedures.

  • Managing monthly face to face provider visits and calendar of events.

  • 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.

  • Work with Population Health Management in scheduling ICT meetings with contracted providers within assigned geographic area.

  • 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

  • Participate in monthly financial review with senior management.

  • Submit all PDM requests throughout the month

  • POD Visits & Communications

  • Analysis & Financial Review

  • Stars & Clinical Metrics Collection

  • Misc.-Administrative Responsibilities

  • Trouble shoot claims issues for providers

  • Investigate grievances

  • Attend various meetings and assist with facilitation

  • Handle all specialty provider issues - calls or emails

  • Handle customer service member issues - calls or emails

Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.

If you require an accommodation based on your physical or mental disability please email: Do not email for an update on your application or to provide your resume as you will not receive a response.

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Medicare Advantage Specialty Provider Relations Representative