Plan Implementation Sr. Representative - Evernorth - Remote
About The Position
The job profile for this position is Plan Implementation Senior Representative, which is a Band 2 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Role Summary: The roles and responsibilities of this department include but are not limited to: responsible for the management of provider demographic and reimbursement data for Client Specific Networks Responsible for timely reporting back to the client contact; work with internal matrix partners to ensure the Cigna provider systems are accurate for claim processing and directories if applicable. Participate in Provider Loading projects as needed to support Cigna efforts.
Requirements
- High School Diploma or GED required
- Experience with root-cause analysis and recommending solutions is required
- Strong technical and analytical skills
- Ability to work independently while managing multiple tasks and meeting deadlines.
- Strong investigative and decision-making skills.
- Proven skills in data management accuracy.
- Excellent written and verbal communication skills
- Strong knowledge of E2E processes and systems
- Critical-thinking
- Priority Setting
- Organizing
- Responsive
- Informing and Customer Focus
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Nice To Haves
- Experience working with Proclaim or HCPM or CPF (Cigna specific system) highly preferred.
- Proficiency with MS Office to include Access and/or Excel (pivot tables, compares, etc.) preferred
Responsibilities
- Selects, implements, and loads the system applications that administer managed care contract provisions
- Coordinates implementation and verification of the loading of fee schedules
- Creates and maintains networks and delivery systems in provider file system
- Responsible for successfully managing the tasks associated with the implementation of new networks
- Responsible for the interpretation, analysis and definition of all CSN contracts, including but not limited to fee schedules, stop loss provisions, per diems and DRG's ASC Groupers
- Works closely with the Business Intelligence team for automation of new and existing networks
- Position will be accountable for all aspects of network data management
- Reviews, researches, and investigates root cause for claim and fallout issues using iTrack, CPF, Proclaim, Stand Alone NetworX Pricer, and Facets, as necessary.
- Performs root cause analysis and individual outreach resolution using Market Specifics, Market Guidebooks, loading instructions, training manuals, and databases/systems
- Maintains current provider data to ensure the quality of the network
- Acts as the initial point of contact for research and resolution of claim issues
- Audits the accuracy of data to ensure all systems are in sync for data integrity.
- Ensures Load of provider data in multiple Cigna systems including CPF/PWB, Facets and Proclaim.
- Acts as a Subject Matter Expert and initiates process improvement projects where appropriate
- Identifies opportunities to automate work as needed
- Adheres to production and quality standards
- Communicates practitioner and vendor demographic / reimbursement setups to matrix partners
- Identifies opportunities for improvement in processes and workflows, as well as volume reduction opportunities.
Benefits
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
