[Hiring] Provider Services Lead Analyst @Cigna Healthcare

Role Description

This position is responsible for account receivable activity for a specific Provider Book of Business tied to an account management team. They will be a key partner to the Provider Relations Executives (PRE) and Managers (PRM) supporting strategic planning to improve provider experience. Ensures timely and accurate claims administration, proactively monitors results, and leverages resources and tools to assist Health Care Providers in managing their accounts receivables. Provides direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. Regularly meets with assigned Health Care Providers to discuss results, review issue trends, and develop action plans for improvement. Engages matrix partners to achieve service improvements and minimize contract interpretation issues. Communicates and educates internally regarding issues/trends to minimize errors and improve claim accuracy. They monitor contractual performance guarantees and late payment interest to minimize financial impacts.

Duties and Responsibilities

• Serves as a key member of the account management team responsible for Accounts Receivable Management.
• Collaborates with provider relations representative and matrix partners to identify, resolve and improve Accounts Receivable issues.
• Key contributor to the development of the provider strategic plan for an aligned book of business.
• Proactively monitors account receivable, performance guarantees and other accounts receivable related issues and communicates results to provider relations representative.
• Drives root cause analysis, trending related to accounts receivable resolution.
• Interacts directly with provider to understand, educate, communicate and resolve accounts receivable issues.
• Participates in face to face meetings with provider relations representatives as needed to act as an accounts receivable Subject Matter Expert.
• Manages accounts receivable issues/corrective action plans.
• Works with account management team to proactively make recommendations on changes to improve service levels based upon root cause.
• Supports service experience review process for specific book of business as defined by the Service Experience Review strategy.
• Contributes to market intelligence, documenting and sharing.
• Achieves and or exceeds Service Level Agreements.
• Responsible for all pre/post contract set up review for assigned book of business.
• Responsible for tracking and trending all accounts receivable related issues timely and accurately in appropriate tools.
• Ability to read and understand data results.

Requirements

• Bachelor's degree or higher strongly preferred or equivalent work experience required.
• 3+ years of experience in benefits and claims administration and/or relationship or project management experience.
• Advanced knowledge of Cigna claim/supporting systems (Proclaim required, Facets highly preferred and PMHS preferred).
• Proficient in Excel and PowerPoint.
• Access knowledge helpful.
• Experience with provider contracting or loading preferred.
• Demonstrated ability to successfully interact with both internal and external customers at all levels.
• Demonstrated ability to perform root cause analysis on claims issues.
• Demonstrated ability to manage and resolve problems to satisfactory completion.
• Project management skills to include time management, task analysis and breakdown and resource utilization.
• Strong facilitation and negotiation skills - demonstrated ability to present detailed technical information to a less knowledgeable audience and negotiate resolutions in a mutually beneficial manner to both Cigna and the provider.
• Demonstrated ability to see the "big picture" - understand how each phase of the claims payment process affects the end result and provider satisfaction.
• Demonstrated ability to handle confrontational situations in a professional manner ending in a better partnership between Cigna and the provider.
• Demonstrated ability to take ownership of tasks/projects and perform work under minimal supervision with exceptional outcomes.
• Some travel required (up to 10% maximum).
• 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.

Benefits

• Annual salary of 66,600 - 111,000 USD / yearly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment.
• 401(k) and company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.