Bilingual Provider Relations Representative

2 weeks ago

Mississauga, Canada The Cigna Group Full time

The role of Provider Relations is to accurately register healthcare providers and maintain a current database in order to support providers by delivering effective and timely communications to ensure seamless claims adjudication and claims payment.

Express Scripts Canada seeks to hire a Provider Relations Representative to work from our Mississauga office. The successful incumbent will review network agreements from pharmacy, medical supplies & equipment, mental health care, vision care, and dental providers for accuracy and completeness and ensure that all providers’ pertinent information is correctly entered into the Express Scripts Canada system.

**NOTE**: This position requires to be on-site at our Mississauga or Montreal Head Office.

Key Responsibilities

Validates completed provider agreements and returns to providers for further review and modifications if information is missing

Ensures that all pharmacy, medical supplies & equipment and dental providers’ required agreement information is entered into the Express Scripts Canada System in a timely manner

Ensures that all pharmacy, medical supplies & equipment, mental health care, visions care, and dental providers’ modifications and terminations are updated in a timely manner

Handles provider, association and software vendor inquiries in a supportive and professional manner

Collaborates with teammates and assists in other team deliverables as required

**Qualifications**:
Post-Secondary school diploma

Advanced level French & English l anguage skill is required.

Excellent written, and verbal communication skills

Knowledge of healthcare/pharmacy, medical supplies & equipment or dental benefit administration and claims processing is an advantage

Strong customer service focus - understanding the Express Way Values

Computer literate, possessing intermediate skills in MS Office (Word, Excel, Outlook), and Adobe Reader and Writer

Strong interpersonal skills with ability to work independently with mínimal supervision; and as a team player willing to take direction

Flexible to new situations and adaptable to change

A thorough understanding of quality assurance and delivery of service excellence

Excellent organizational skills, effective time management, and the ability to shift priorities working within established timelines

Demonstrates initiative (learn processes and procedures, various benefits) and displays self-motivation to grasp new concepts quickly

Ability to analyze, problem-solve and mediate difficult situations

Results-oriented paying attention to detail.

**French Job Summary**:
Le Service des relations avec les fournisseurs soutient les fournisseurs de soins de santé et communique avec eux en temps opportun et afin de s’assurer de la soumission adéquate et du paiement exact des demandes de règlement. De plus, cette équipe veille à l’inscription des fournisseurs et à la gestion de la base de données des fournisseurs de soins de santé.

Le titulaire du poste devra passer en revue les ententes conclues avec les fournisseurs de services de médicaments, d’équipement médical et fournitures médicales, de counseling en santé mentale, de soins de la vue et de soins dentaires afin de s’assurer de leur exactitude et de leur intégralité. Le titulaire devra par ailleurs s'assurer que tous les renseignements sur les fournisseurs qui ont signé une entente sont saisis correctement dans le système d'Express Scripts Canada.

Responsabilités principales

Valider les ententes remplies par les fournisseurs et retourner au fournisseur les documents aux fins de vérification et de modification en cas de renseignements manquants.

S’assurer que tous les renseignements pertinents sur les nouvelles ententes avec les fournisseurs de services de médicaments, d’équipement médical et fournitures médicales, de counseling en santé mentale, de soins de la vue et de soins dentaires sont rapidement saisis dans le système.

S'assurer que toutes les modifications aux renseignements sur les fournisseurs de services de médicaments, d’équipement médical et fournitures médicales, de counseling en santé mentale, de soins de la vue et de soins dentaires ainsi que les résiliations de fournisseurs sont effectuées en temps opportun.

Répondre aux demandes des fournisseurs, des associations et des vendeurs de logiciels d’une manière professionnelle et être en mesure de leur offrir le soutien approprié.

Collaborer avec les collègues afin d’aider l’équipe à réaliser ses objectifs au besoin

Compétences recherchées

Être titulaire d'un diplôme d'études secondaires.

Être bilingue (français et anglais) constitue un atout.

Présenter d'excellentes aptitudes en communication orale et écrite.

Avoir une connaissance de la gestion des régimes de soins de santé, de soins médicaux complémentaires (équipement médical et fournitures médicales - EMFM), de counseling en santé mentale, de soins de la vue ou

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