Accounts Receivable Specialist

2 weeks ago

united states work at home The Cigna Group Full time

Overview:As a member of the Provider Solutions and Operations team, this role Serves as a key member of the Provider Solutions Circle of Excellence (PSCOE) responsible for providers’ Accounts Receivable Management activity for Non-Dedicated Providers for commercial lines of business.  This is an externally facing role.    Responsibilities:Ensures timely and accurate claims administration, monitors results, and leverages resources and tools to assist providers in managing their accounts receivablesResponsible for tracking and trending all accounts receivable related issues timely and accurately in appropriate toolsEnsure provider satisfaction for all claim project resultsCollaborates with local market matrix partners to identify, resolve and improve Accounts Receivable issuesContributes to provider strategic action plans for assigned markets; as requestedDrives root cause analysis and trending related to Accounts Receivable resolutionServes as Subject Matter Expert internally and externally on claim processing and reimbursement policiesCommunicates and educates regarding issues/trends to minimize errors and improve claim accuracyInteracts directly with provider to understand, educate, communicate and resolve accounts receivable issuesParticipates in provider meetings with local team to act as an Accounts Receivable Subject Matter Expert as requestedWorks with account management team to proactively make recommendations on changes to improve service levels based upon root causeEngages matrix partners to achieve service improvements and minimize contract interpretation issuesProvides direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. Participates in cross functional project initiatives and workgroups, as requestedAchieves and/or exceeds Service Level AgreementsQualifications:College degree or equivalent work experienceAdvanced knowledge of proclaim claim and supporting systemsProficient in ExcelExperience with Cigna claim processing, claim appeals, or claim quality preferredDemonstrated ability to successfully interact with both internal and external customers at all levelsDemonstrated ability to perform root cause analysis on claims issuesDemonstrated ability to manage and resolve problems to satisfactory completionSkills to include time management, task analysis and breakdown and resource utilizationDemonstrated ability to present detailed technical information to a less knowledgeable audience and negotiate resolutions in a mutually beneficial manner to both CIGNA and the providerDemonstrated ability to see the "big picture" - understand how each phase of the claims payment process affects the end result and provider satisfactionDemonstrated ability to handle confrontational situations in a professional manner ending in a better partnership between CIGNA and the providerDemonstrated ability to take ownership of tasks/projects and perform work under minimal supervision with exceptional outcomesDemonstrated ability to read and understand data results

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