7 days old

Provider Services Lead Representative - Phoenix and Tuscon

Phoenix, AZ 85003
  • Job Code
Position Description

The Provider Education Specialist (PES) is responsible for providing expertise in the area of Risk Adjustment (RA) coding & documentation for assigned provider groups. The PES will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding and ensure that providers understand the STAR CPTII coding requirements. The PES will assist in the daily operations for developing and managing the Independent Provider Network that includes educating, servicing, and training health care professionals in the accuracy of medical record documentation and code capture. To ensure understanding of policies and procedures and to work with partners to support effective communication with contracted healthcare professional

Primary Responsibilities

Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs Educates and assists providers in understanding the CMS-HC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding to ensure compliance with state and federal regulations Supports the providers by ensuring that documentation supports the submission of relevant ICD -10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirements Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes Reviews selected medical documentation to determine if assigned diagnosis, procedure codes and ICD-10 codes are appropriately assigned Refers inconsistent or incomplete patient treatment information / documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment Monitor and present coding initiative program performance with assigned health system/providers


  • A Bachelor's degree in core sciences or allied medical sciences is preferred, High School Diploma or equivalent is required
  • Certification from either American Medical Information management associated (AHIMA) or American Academy of Professional Coders (AAPC) is required:
    • Clinical Documentation Improvement Practitioner (CDIP)
    • Certified Professional Coder (CPC)
    • Certified Risk Adjustment Coder (CRC)
    • Certified Coding Specialist for Providers (CCS-P)
    • Certified Coding Specialist for Hospitals (CCS-H)
    • Registered Health Information Technician (RHIT)
    • Registered Health Information Administrator (RHIA)

Other Required/Preferred Skills

Prior experience training professional adult learners in a medical setting is required Ability to travel locally 50% to assigned health system/providers is required Minimum of 3 years' of medical coding experience at either an inpatient or outpatient medical setting Extensive knowledge base on ICD-10-CM guidelines and its demonstration on medical code selection & sequencing Well versed on medical terminologies, etiology of disease and anatomy/physiology Working knowledge of Evaluation and Management (E&M) guidelines, billing & CMS HCC methodology Understanding of HIPAA laws and privacy policies in a care setting Strong knowledge of Microsoft skills required; Excel, Word and Power Point Strong verbal and written communication skills Accepts the need for change and willingly adjusts to new work processes. Ability to positively handle challenges and diverse approaches to work and develops solutions to problems. Demonstrates a commitment to excellent customer service at all times.

Provider Services Analyst

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: 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.

Posted: 2021-06-09 Expires: 2021-07-08
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Provider Services Lead Representative - Phoenix and Tuscon

Phoenix, AZ 85003

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