Provider Data Senior Representative - Careallies- Harlingen TX - Hybrid

Job Location: Harlingen, Texas (Hybrid) - Must live in this area of Texas

SUMMARY:

The Provider Engagement Department within CareAllies is responsible for the financial and operational activities of provider engagement. 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.).  This role supports the CareAllies IPAs in the market.
 

RESPONSIBILITIES:

• Researches and resolves provider claim issues
• Identifies the right parties or resources, internally and externally, to resolve issues timely
• Prepares materials, distributes reports for assigned provider groups
• Assists with scheduling, coordinating and preparing for internal and external meetings
• Submits change requests to update provider demographics, credentialing and contract changes
• Accounts Payable submission and tracking of payments
• Maintains accurate provider data information utilizing Salesforce
• Tracks and monitors provider updates
• Provides support to the Provider Engagement team
• Coordinates with the Market Medical Executives to schedule PQPMD training sessions
• Ability to attend evening meetings when needed

Qualifications:

• Bachelors degree preferred
• Strong knowledge of healthcare insurance industry, terminology, provider networks, contracting and credentialing highly preferred
• Working knowledge of Microsoft Office 365 and vlookup
• Strong analytical and problem-solving skills
• Excellent communication skills – verbal, written and presentation
• Ability and willingness to share knowledge
• Detail oriented with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards)
• Being a positive role model and having the ability to work independently and in conjunction with co-workers of all levels

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.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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.

The Cigna Group 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.