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Provider Network Engagement Representative - Nashville, TN - Alegis Care at Cigna

Posted in Health Care 16 days ago.

Type: Full-Time
Location: Nashville, Tennessee

Job Description:

Job Description

This individual reports directly to Operations Manager and works with targeted physician offices in the Nashville, TN area to educate and guide offices around the Alegis program and contract questions. Individual then serves as a primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization. Develops and maintain positive relationships with providers and other cross-functional, cross-collaborative team including CMA, Operations, Engagement, Coding, Finance, Marketing, Stars and Alegis providers. Will also support the activities of the Alegis Chronic Care Operations Department.

What you must have

  • Bachelor's degree and/or equivalent work experience of 3+ years in Managed Care and/or Provider Contracting required.

  • Knowledge of healthcare provider network systems, contracting and credentialing requirements, contracts, and terminology.

  • Knowledge of Provider onboarding process, system applications, and procedures.

  • Ability and willingness to share knowledge as well as train, develop, and coach individuals with varying levels of experience.

  • Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).

  • Act with a sense of urgency to research questions or issues brought by the team. Identify the right parties or resources to resolve these issues. Follow up with these parties to drive resolution and provide on-going feedback to individual(s) who raised the question or issue.

  • Positive role model and have the ability to work independently and in conjunction with co-workers of all levels.

  • Strong negotiation, presentation, analytical and problem-solving skills.

  • Excellent communication skills - verbal, written and presentation.

  • Working knowledge of Microsoft Office. Ability to quickly learn and master basic contracting platforms and databases.

  • This position is expected to travel 50-75% of the time to local provider offices; a residence in the Nashville, TN area is required.

  • Car and valid driver's license required- mileage reimbursement provided

Duties and Responsibilities

  • Manage contracting process for professional network and leads transition for assigned territory

  • Responsible for creation and delivery materials to educate providers and provider staff on policies and procedures, contracting, quality, coding, service line initiatives and financial performance efficiencies.

  • Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding and Stars/quality performance; support coding and stars initiatives through network operations initiatives and contract negotiations.

  • Responsible for the strategy and execution of stars, coding, and unit cost performance of assigned territory.

  • Maintain internal partnership with medical economics, legal, compliance, claims, health services, provider data management to operationalize contracting by meeting agreed parameters with legal counsel to lessen risk and improve operational

  • Organizes and conducts operating committee meetings with provider/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities

  • Initiates and maintains effective channels of communication with providers, office staff and matrix partners

  • Assist in analysis of monthly cost trends for the direct market, including recommending solutions and assist in identifying action plans to remediate provider medical cost trends.

  • Perform special projects and other duties assigned by leadership.While this job description is intended to be an accurate reflection of the duties involved in this position, the company reserves the right to add, remove or alter duties when business need dictates.

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

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Cigna 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.

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