Provider Services Lead Analyst - Cigna Healthcare - Remote

POSITION SUMMARY:

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

POSITION 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)

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About Cigna Healthcare

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.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.