Provider Relations Advisor - Work from home, New York at Cigna in Queens, New York

Job Description:

Remote, Work from home, New York

Summary:

This individual reports directly to the New York Medicare Market President and will strategically develop and maintain provider network, ensure positive relationships with providers, and support market leadership in executing growth and cost containment strategy. Responsible for performance management of assigned groups for HEDIS/Quality measures. Will assist in value based contracts; maintaining the contractual and operational relationship with providers , analysis and interpretation of medical cost trends, ensuring providers are following compliance guidelines, supporting projects and activities assigned by market leadership. Also develop and maintain positive relationships with all internal cross-functional, cross-collaborative teams including Network operations, Sales, Health Services, Coding, Finance, Marketing, Stars and provider engagement.

Responsibilities:

• Formulate and execute value based agreements to achieve quality and financial results.
  
  


• Initiates and maintains effective channels of communication with providers, office staff and matrix partners
  
  


• Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality, coding, service line initiatives and financial performance.
  
  


• Maintain internal partnership with medical economics, legal, health services, provider data management to operationalize contracting by meeting agreed parameters with legal counsel to lessen risk and improve operational efficiencies.
  
  


• Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding and Stars/quality performance; support coding and stars initiatives through network operations initiatives and contract negotiations.
  
  


• Assist in coordinating provider agreements, amendments, and letters of agreement with non-contracted providers as needed by manager and/or director
  
  


• Maintain provider file folders in master files and online databases
  
  


• Complete and maintain provider rosters reflecting accurate demographic information.
  
  


• Perform special projects and other duties assigned by leadership.
  
  

Provider Orientations and Operational Meetings

• Organizes and conducts operating committee meetings with provider/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities
  
  


• Gather operational concerns expressed at operational meetings and work with market leadership to resolve any operational issues
  
  


• Initiates and maintains effective channels of communication with providers, office staff and matrix partners
  
  

Operational issues with Providers

• Assist in research and investigate provider concerns regarding claims payment, appeals, and resolution of operational issues when needed.
  
  


• Respond to provider questions, phone calls, and inquiries in a timely fashion.
  
  

Other Duties and Responsibilities

• Assist in analysis of monthly cost trends for the direct market
  
  


• Recommend solutions and assist in identifying action plans to remediate provider medical cost trends.
  
  


• Participate in regularly scheduled meetings with other departments; offer substantive feedback to questions and research thoroughly any unknown issues
  
  


• Be available during working hours to coworkers and others for questions; including multitasking on calls and other similar scenarios
  
  


• Other duties and responsibilities as assigned
  
  

Qualifications:

• Bachelor's degree and/or equivalent work experience
  
  


• 5 years or more Medicare based or Medicare Advantage experience, preferred
  
  


• Additional Skills: Excellent presentation, communication and customer service skills required. Excellent time management and relational skills. Demonstrated analytical skills. Strong organizational abilities with attention to detail.
  
  


• Computer Skills: Microsoft Word, Excel, PowerPoint
  
  


• This role requires 25-50% of local travel to providers.
  
  

This role is either located in NYC or requires regular travel to the NYC site. Employees who work in the NYC office or attend in-person work meetings and events in New York City must be fully vaccinated against COVID-19, unless there is an approved medical or religious exemption. Note that religious exemptions are not permitted in New York for patient-facing roles

For this position, we anticipate offering an annual salary of $72,100 - $120,100, depending on relevant factors, including experience and geographic location.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we'll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the "Life at Cigna" tab on our careersite: www.cigna.com/careers

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.