Cigna Medicaid Nursing Facility Provider Relations Representative (work at home- must be located in Bedford, McAllen, or Tyler, TX) in McAllen, Texas
This position serves as the primary contact for Nursing Facility providers and staff to assist in maintaining positive relationships between Cigna-HealthSpring and the provider network. This position is responsible for serving 50 counties, a Network of over 400 Nursing Facility Providers, and 60,000 members. This resource will report directly to the Director of Network Operations and Provider Relations.
- Conducts regular external meetings to educate Nursing Facilities on health plan operations, policies and procedures and facilitate timely resolution of provider inquiries
- Initiates and maintains effective channels of communication with providers and related office staff.
- Coordinates or participates in cross functional/department collaboration with other internal departments, including but not limited to Claims, Health Services and Community Outreach in order to develop solutions for strategic business needs
- Demonstrates knowledge of Providers in assigned geographic area. Understands interrelationships among providers in local market.
- Create and deliver materials to educate providers and provider staff on quality and service line initiatives
- Attends and represents Cigna-HealthSpring at State sponsored meeting
- Responds to provider inquiries, concerns, complaints, appeals and grievances.
- Well-established relationship with internal staff
- Assists in the creation of policies and procedures for the department on standardizing responses to provider inquiries, complaints, appeals and grievances.
- Other projects and duties as assigned.
- High School Diploma or equivalent; Bachelor's degree preferred
- At least 3 or more years of experience in customer service, claims and/or payor related experience
- Intimate knowledge of STAR PLUS/managed care
- Strong analytical skills
- Self-motivated and ability to operate independently
- Strong written and verbal communication skills and experience with formal presentations
- Superior problem solving, decision-making and negotiating skills
- Ability to use PC software and multiple CIGNA systems
- Team player with proven ability to develop strong working relationships within a complex organization.
Primary Location: Bedford-Texas
Other Locations: United States-Texas-Tyler, United States-Texas-McAllen
Job: Provider--Network/Data Mgmt
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 75 % of the Time
Job Posting: Mar 13, 2018, 2:35:20 PM
Cigna is an equal opportunity employer, which means we offer equal treatment to all applicants. Cigna does not discriminate, either directly or indirectly, on the grounds of race, color, sex, gender identity, sexual orientation, nationality, national origin, ethnic origin, religion, beliefs or creed, age, disability, marital status, veteran status or genetic information in any area of recruitment. In some countries we ask for information on the ethnic origin, gender and disability of our applicants for the purpose of monitoring equal opportunity. If you have a disability and would like to indicate as part of your application any relevant effects of your disability and any adjustment which you consider should reasonably be made to the process to assist your application, please do so in the relevant field during the application process.