CareAllies Provider Engagement Internal Representative (Provider Data Senior Associate) Band 2

Where You’ll Work

Cigna Corporation (NYSE : CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve.

We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products.

Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions.

Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world healthier place.

What difference will you make?

This role will work with a subdivision within Cigna called CareAllies. CareAllies is a Management Company that works side-by-side with providers and payer entities to help improve the quality, value and the experience of care for patients, to make health care better for everyone.

As a part of the Provider Engagement Team, you will be working closely with providers to accelerate their transition to value-based care and to help them manage the long-term health of their patients.

CareAllies’ consultative approach emphasizes physician engagement, delivery system organization and culture change, actionable data and analytics, as well as patient engagement to support treatment plans.

We collaborate with providers to drive change and ensure success in a value-based market.

What You’ll Do

CareAllies Provider Engagement Internal Representative is designed for someone beginning their career in healthcare. You will gain a ground level up understanding of the Management Company and how we support our Clients in the market place.

You will be provided the opportunity to develop management skills and provide experience working in a dynamic, flexible work environment.

The Provider Engagement Internal Representative role offers :

Roles and Responsibilities

• Develops and maintains positive relationships with physicians, providers and practice manager, provider office staff to research and resolve claims issues in a timely
• Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery.
• Provide tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management
• Partners with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to facilitate Provider engagement team needs
• Identifies the right parties or resources, internally and externally, to resolve issues timely
• Prepare materials, distributes reports for assigned provider groups
• Assists with scheduling, coordinating and preparing for internal and external meetings. Ability to attend evening meetings when needed
• Submits change requests to update provider demographics, credentialing and contract changes in Operating systems
• Accounts Payable submission and tracking of payments
• Maintains accurate provider data information utilizing Salesforce
• Tracks and monitors provider updates
• Tracks and monitors and reports on key program performance metrics, such as utilization, coding, and STARs / quality performance.

Qualifications

What you need to do the job

• High School Diploma or GED
• Knowledge of health insurance industry, terminology, provider networks, contracting and credentialing highly preferred
• Excellent communication skills verbal, written and presentation.
• Experience in public speaking is a plus.
• Intermediate level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.)
• Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.
• Creative thinker with ability to think outside the box and translate ideas into actions
• Strong problem solving skills

Additional Information

• Location : Nashville, TN
• Work Designation : This role is a Flex role, which requires a combination of in-office days, WAH, and field work. Car and Valid Driver’s License is required (mileage reimbursement provided)
• Schedule : In this role you may need to attend meetings with providers. These meetings are held at clients convenience, which can include early morning (7am) or evening (6pm).

Schedule is provided in advance and you will be asked to support occasional weekend conferences (2 x year).

Last updated : 2024-04-28