Provider Services Analyst

Cigna Phoenix , AZ 85002

Posted 2 months ago

  • A candidate has been identified for this role*

Job Description

Provider Services Analyst - (16000899) -

Description

To assist in the daily operations for developing and managing the Independent Provider Network, that includes educating, servicing, and training health care professionals in the accuracy of medical record documentation and code capture. To ensure understanding of policies and procedures and to work with partners to support effective communication with contracted healthcare professionals. Experience in provider relations is needed.

Responsibilities

  • 360 (physical exam) Documentation and Training

  • Proactive follow-up for non-compliant 360s and re-education

  • Daily support of physician/staff for coding and documentation questions pertaining to Medicare Advantage and Risk Adjustment

  • Formal training and education pertaining to Medicare Advantage and Risk Adjustment

  • Utilization of reporting and other tools to identify HCC capture opportunities

  • Assist CMCRs with retrospective audits when necessary

  • RADV/OIG audits when required

  • HEDIS audits

  • Collaborate with Network Operations

Change Management

  • Accepts the need for change and willingly adjusts to new work processes.

  • Ability to positively handle challenges and diverse approaches to work and develops solutions to problems.

  • Looks for opportunities for process improvement and reports that information to appropriate person.

Enhance Customer Service

  • Demonstrates a commitment to excellent customer service at all times.

  • Treats customers with dignity/respect.

  • Maintains patient confidentiality.

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at

Qualifications

  • High school diploma required with college preferred.

  • Strong knowledge in medical terminology, anatomy and physiology, ICD-9/ICD-10 and CPT-4 coding with 2 or more years of working knowledge required.

  • Experience with HCC coding strongly preferred.

  • Medical records auditing experience preferred.

  • CPC or CCS P certification required

  • Good verbal and written communication skills required.

  • Strong internal and external customer service skills.

  • Microsoft skills required in both Word and Excel.

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Provider Services Analyst

Cigna