Tag Archives: Provider Data Senior Associate

Some responsibilities include:

Description

SUMMARY:
This role supports the Network Operations Administrators and Representatives. The Network Operations Department is responsible for the financial and operational activities of the provider network. In this role, you will be exposed to all aspects of a Coordinated Care Organization (financial understanding, provider network building, conflict/issue resolution, contracting, claim payments, meetings, training, etc.). Primarily, this role will be spent internally with substantial administration support but may include limited travel within the city.

RESPONSIBILITIES:
· Researching and resolving provider issues such as authorization and claim issues
· Prepares documentation for meetings, schedules meetings, and educates providers regarding member benefits and the referral process
· Develops, maintains, and distributes reports for respective market
· Credentialing of new providers that are interested in joining the Cigna-HealthSpring network
· Assists with bonus distribution for high performing providers
· Monitoring and resolving call trackers and grievances that are assigned to Network Operations

Qualifications

Bachelor’s degree strongly preferred

· Strong ability to act as a liaison
· Strong time management skills; highly organized and detail oriented
· Ability to work independently
· Excellent verbal and written communication skills
· Experience in MS Office Suite.