Debra Wright Email & Phone Number

Aston, Pa, Us

United States

• Managed several high-profile provider groups in New York City.• Monitored service capabilities, ensured accuracy in provider enrollment, claims payment and contract interpretation.• Served as provider’s single point of contact for escalated access to care concerns and provider reimbursement discrepancies.• Conducted weekly meetings with hospital leadership, enrollment and claim’s teams to ensure timely resolution of open escalations pertaining to enrollment, claims, contract/credentialing.

• Liaison between International Markets (IM) and Cigna Healthcare (CHC) Network teams.• Supported medical cost management solutions, identifying gaps and opportunities.• Served as US Network SME for Request for Proposal requests, providing quantitative and qualitative information about US Medical, Dental and Pharmacy Network.• Responsible for implementation/management of all reason not covered codes associated with US Network and out-of-network vendors.• Managed relationship with out-of-network pricing vendors.

• Served as the single point of accountability for CHC Provider Relations and Accounts Receivable Managers to address escalated provider complaints for all International Market plans (North America, Belgium, United Kingdom, Middle East, Asia Pacific)• Addressed escalated quality of care, service issues and provider discount disparities from both internal and external matrix partners. • Performed root-cause analysis trending, to identify process improvements. Partnered with cross-functional teams from all global markets to ensure proactive measures were taken to mitigate future escalations.• Produced reporting required by Senior Network Managers and Directors, relative to US Network and IM US-incurred claim utilization.• Served as Network SME for projects (provider termination letters, provider directory enhancements, Consolidated Appropriations Act (CAA) changes to non-participating provider reimbursements, etc.)

• Supported CignaLinks Alliance partners to ensure successful delivery of service, by responding to inquiries and operational issues.• Created test plans and coordinated the implementation of system enhancements to the CignaLinks programs with internal departments.• Coordinated refresher trainings with other departments on current CignaLinks processes.• Tracked all mailbox inquiries, to provide monthly reporting on trends and identify system enhancement opportunities.