Bedford, United States
about 1 year ago
Maintains current provider data for the largest, most complex account structures. Maintains provider data to ensure the quality of the network. Coordinates provider enrollment, and assists with coordination of meetings with providers for training, contracting, and reporting. May be responsible for reporting and tracking provider calls and complaints. Updates directories for all contracted organizations. May be responsible for reporting and tracking provider calls and complaints
Duties and Responsibilities
Responsible for the loading of Provider data into multiple systems - i.e. claims, directory, HSD Tables
Act as a SME (subject matter expert) for provider demographic loading into all Cigna-HealthSpring systems.
Conduct provider outreach via outbound calls, fax blasts, email requests, and USPS mail for demographic validation.
Act with a sense of urgency to research questions or issues raised by internal or external customers.
Identify the right parties or resources, internally and externally, to resolve issues timely.
Resolve issues and complete work within established CMS timeframes, ensuring compliance.
Intake provider data from multiple sources.