This position serves as an integral member of the team for the Cigna LifeSource Transplant Network®. This resource will report directly to the Provider Contracting Senior Manager and will be responsible for managing the day to day provider relations issues for the Cigna LifeSource Transplant Network®.
DUTIES AND RESPONSIBILITIES
Manages provider relations issues for the Cigna LifeSource Transplant Network which currently consist of 173 Cigna LifeSource Providers, as well as managing provider relations issues for new providers added to the Cigna LifeSource Transplant Network.
Manages elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues.
Responds to provider inquiries, concerns, complaints and grievances in a timely manner, including but not limited to escalated claims issues.
Examine the root cause of service complaints and leads projects allowing for long term resolution collaborating with internal and external matrix partners.
Coordinates provider interactions with the contracting leads and matrix partners as necessary.
Orientation for all new Cigna LifeSource Providers.
Negotiate competitive rates for letter of agreements for transplant services and Chimeric Antigen Receptor T-Cell (CAR-T) Therapy for non-contracted transplant programs with existing Cigna LifeSource providers and non-Cigna LifeSource providers.
Key point person for coordinating with internal matrix partners to maintain the necessary updates to the Cigna LifeSource Provider Reference Guide.
Assist in the smooth operation and administration of provider agreements.
Initiates and maintains effective channels of communication with providers, matrix partners, particularly with claims, case management and provider services staff in the field.
Demonstrates knowledge of providers on a national level.
Maintain various grids for the department i.e. facility contacts and local contract grid.
Facilitate training for claims and case management regarding letters of agreements.
Other projects and duties as assigned.
Central point of contact for providers for pilot project for email claim automation. And main point of contact as this project extends to all providers.
Central point of contact for providers once electronic claim submission is implemented.
Cross check accuracy of rates for Network Access Clients and modify rates and language edits as warranted.
Bachelor’s degree preferred or five years Cigna Lifesource experience and experience in resolving provider relations issues.
Expertise in researching and resolving escalated claims issues.
Strong analytical skills.
Exceptional customer service skills.
Superior problem solving, decision-making and negotiating skill sets.
Ability to manage in a high paced production environment.
Knowledge of hospital and physician managed care services.
Strong written and verbal communication skills.
Experience with formal presentations beneficial.
Ability to use PC software and multiple Cigna systems i.e. One View, Proclaim, Power, Facets and PPN.
Team player with proven ability to develop strong working relationships with matrix partners.
Experience with provider negotiations advantageous.
For this position, we anticipate offering an annual salary of $61,000 – $101,600, 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
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: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
Cigna 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.