QA and Testing Advisor
The Cigna Group
Job Level
Mid-LevelSenior
About the role
- Job Summary: The Phyisican Recruiter is responsible for maintaining and expanding Dane Street’s physician panel. This includes negotiating physician fees within pre-established guidelines, onboarding new physicians based on client demand, and ensuring that all open service requests (OSRs) are resolved promptly. The ideal candidate will leverage existing relationships and industry knowledge to strategically grow the network and support business operations.
- Panel Maintenance & Growth: Understand client fee schedules and turnaround time (TAT) requirements to negotiate physician agreement terms.
- Panel Maintenance & Growth: Conduct outreach for refunds or recoupments; collaborate with Finance and Legal when collections are required.
- Panel Maintenance & Growth: Maintain existing physician records, including: Fee updates; W9 and remittance changes; Profile instructions; Doctor groups; Deactivations/reactivations.
- Panel Maintenance & Growth: Research and source new panel options as needed.
- Panel Maintenance & Growth: Onboard new physicians based on client needs.
- Panel Maintenance & Growth: Negotiate rates and contract terms per company guidelines.
- Panel Maintenance & Growth: Collect necessary documentation (agreements, CVs, applications, W9s, NPDB reports).
- Panel Maintenance & Growth: Coordinate with the Director of Operations to finalize fees.
- Special Assignments & Contract Negotiations: Lead contract renegotiations for existing physicians (agreements, pricing changes, special initiatives).
- Special Assignments & Contract Negotiations: Handle complex client requests, especially those involving niche specialties or urgent network gaps.
- Special Assignments & Contract Negotiations: Assist physician reviewers with technical issues or case-specific inquiries.
- Special Assignments & Contract Negotiations: Fulfill high-priority OSRs by recruiting appropriate specialists and providing daily updates on progress.
- Special Assignments & Contract Negotiations: Collaborate with operations to ensure network alignment with business needs.
- Additional Duties: Support other projects and tasks as assigned by leadership.
- Additional Duties: Stay current on industry trends and compliance requirements.
- Qualifications: Education: Associate's or Bachelor's degree preferred.
- Qualifications: 3–5 years of physician recruitment experience in a healthcare or insurance environment.
- Qualifications: Familiarity with provider networks and healthcare operations is strongly preferred.
- Qualifications: Deep understanding of physician recruitment, medical specialties, and related terminology.
- Qualifications: Strong negotiation and communication skills.
- Qualifications: Working knowledge of federal/state healthcare compliance standards.
- Qualifications: Excellent time management, critical thinking, and organizational abilities.
- Qualifications: Proficiency in Microsoft Office and general computer systems.
- Working Conditions: Primarily remote with extended periods of computer work.
- Working Conditions: Occasional lifting, bending, or travel may be required depending on business needs.
- Technical Requirements (Remote Work): Must supply and maintain reliable, high-speed internet.
- Technical Requirements (Remote Work): An uninterrupted internet connection is a requirement for this role.
Requirements
- Education: Associate's or Bachelor's degree preferred.
- 3–5 years of physician recruitment experience in a healthcare or insurance environment.
- Familiarity with provider networks and healthcare operations is strongly preferred.
- Deep understanding of physician recruitment, medical specialties, and related terminology.
- Strong negotiation and communication skills.
- Working knowledge of federal/state healthcare compliance standards.
- Excellent time management, critical thinking, and organizational abilities.
- Proficiency in Microsoft Office and general computer systems.
