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Medicare Provider Relations Representative

4 months ago

Birmingham, Alabama, United States The Cigna Group Full time
The job profile for this position is Provider Relations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

SUMMARY:

This position is an external provider facing role with account management responsibilities for a medium to low complex book of business. Territory for this role is Alabama and candidate MUST reside in Alabama. The role is accountable for the overall provider experience by working in collaboration with matrix partners to drive on-going service improvements, understand, articulate and resolve service impacts, and drive the overall provider strategic planning solutions. This individual is empowered within their scope to make decisions as it pertains to the experience with Cigna, is required to have local market knowledge and visibility, builds and continuously improve the relationship between Cigna and the provider.

*A note to internal candidates:

This role is set to convey and is open to all Cigna employees, including those already designated to move with HSCS. Please contact recruiter Betsy DeFelice with any questions.

DUTIES AND RESPONSIBILITIES:

  • Accountable for the end-to-end provider experience and overall service delivery for assigned Book of Business aligned to medium to low complex providers
  • Leads, collaborates, and supports local market direction as it relates to improving the provider experience
  • Creates and maintains individual provider strategic action plans
  • Proactively identify new opportunities and risks for providers at market or national level and drives resolution
  • Exercises good judgment and discretion to support the provider experience
  • Responsible for capturing, documenting, and sharing market intelligence; use market intelligence to develop and drive strategic improvements
  • External facing with providers in assigned BOB
  • Collect, analyze, interpret, translate and distribute provider informatics, reports, dashboards
  • Track and monitor performance guarantees for assigned BOB
  • Promotes Provider Index score improvement through proactive and effective service and support of network
  • Review provider reports/dashboard with individual providers
  • Proactively educate providers on Cigna's business objectives, standard operating procedures, policies and programs to influence behavior and how to work with Cigna
  • Serve as a provider advocate both internally and externally
  • Understands and applies service culture principles and methodology
  • Serves as a provider advocate both internally and externally
  • Serves in a consultative role or subject matter expert to key matrix partners
  • Develops and participates in presentations to existing and prospective providers and/or clients
  • Serves as advocate in external community, representing CIGNA to medical societies and external provider associations.
  • Manage joint operating committees, including agenda development, facilitating appropriate meeting participation and follow up activities

PREFERRED QUALIFICATIONS:

  • College degree preferred or equivalent work experience.
  • 5+ years of experience in provider relations or health care
  • Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills.
  • Ability to use PC software and multiple Cigna systems.
  • Understanding of medical insurance products and associated provider issues
  • Ability to lead an account management team
  • Ability to work in a matrix environment.
  • >25% travel

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.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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.