Medicaid Nursing Facility Provider Relations Representative (work at home- must be located in Bedford, McAllen, or Tyler, TX)','18001152','!*!SUMMARY: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. RESPONSIBILITIES:Conducts regular external meetings to educate Nursing Facilities on health plan operations, policies and procedures and facilitate timely resolution of provider inquiriesInitiates 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 needsDemonstrates 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 initiativesAttends and represents Cigna-HealthSpring at State sponsored meetingResponds to provider inquiries, concerns, complaints, appeals and grievances.Well-established relationship with internal staffAssists 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.','!*!REQUIREMENTS:High School Diploma or equivalent; Bachelor's degree preferredAt least 3 or more years of experience in customer service, claims and/or payor related experienceIntimate knowledge of STAR PLUS/managed careStrong analytical skillsSelf-motivated and ability to operate independentlyStrong written and verbal communication skills and experience with formal presentationsSuperior problem solving, decision-making and negotiating skillsAbility to use PC software and multiple CIGNA systemsTeam player with proven ability to develop strong working relationships within a complex organization.','Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com','United States-Texas-Bedford','United States-Texas-Tyler, United States-Texas-McAllen','','','','','Provider--Network/Data Mgmt','Yes','Yes','Full-time','Day Job','Regular','Standard','Individual Contributor','Yes, 75 % of the Time','Mar 13, 2018','Medicaid Nursing Facility Provider Relations Representative (work at home- must be located in Bedford, McAllen, or Tyler, TX)
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