Provider Engagement Representative - Careallies - Hybrid - Houston, Texas

***Must live in the Houston Area.

SUMMARY:

Serves as primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization. Develops and maintains positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs.

• Requires up to 30-50% local travel to providers in the Houston, TX market area
• Two in office days per week required, remaining three field based/work from home
• Car & valid driver's license required (mileage reimbursement provided)

RESPONSIBILITIES:

• Provide tactical operations support to assigned groups, including contracting, credentialing, data integrity, communications, and relationship management
• Complete orientation/onboarding of new physicians
• Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance
  • Visit all PCPs monthly
  • Schedule recurring monthly meetings with key staff with  PCPs on a performance improvement plan
  • Include all support team members including performance improvement team
  • Visit capped specialists every other month
  • Visit fee for service specialists quarterly
• Ensures all provider interactions are documented in Salesforce
• Prepares and delivers presentations with providers, provider staff, and/or physician leadership during monthly operational meetings 
• Collaborate and present at office staff meetings
• Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding, and STARs/quality performance
• Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery
• Prepare materials and participate in monthly financial review with senior leadership
• Partners with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs
• Work closely with internal representatives for needs and support
• Other Duties as assigned

Qualifications:

• Bachelor’s degree preferred (with a Healthcare concentration),
• At least 2 years of experience in healthcare administration or provider relationship management preferred.
• Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).
• Be a positive role model and have the ability to work independently and in conjunction with co-workers of all levels.
• Strong analytical and problem-solving skills.
• Excellent communication skills – verbal, written and presentation.
• Strong analytical and problem solving
• Basic to Intermediate level of Excel preferred (knowledge of pivot tables, vlookup, etc a plus)

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