Provider Network Operations Advisor - Cigna Healthcare - Hybrid

- Support the management and implementation of provider, hospital, and ancillary networks by researching and resolving provider data issues, including demographic, claims, and system loading errors. - Troubleshoot issues escalated by Market Network Advisors using Cigna systems such as HCPM, Cognos, and the Developer Database. - Respond to questions from the Contracting team and matrix partners related to provider locations, policies, and data accuracy. - Perform rate and fee schedule audits upon request. - Support accurate loading of provider contracts and reimbursement methodologies.

- Create, manage, and maintain Market Guidebooks, including rate updates, provider inclusion/exclusion, and audit documentation. - Advise Market leadership and the National Alternative Access Network Manager on market-specific network dynamics. - Participate in quarterly reviews, identify corrections, and assist with provider terminations, additions, and updates.

- Serve as the market subject matter expert for Alternative Access Networks, including inclusion/exclusion criteria and anchor providers. - Develop and maintain the AAN field guide for Contracting teams. - Coordinate, edit, and approve AAN communications, such as provider notices and Sales materials. - Conduct provider research and approve mailing lists for new or expanded product offerings. - Perform ongoing network maintenance, answer questions, and resolve issues. - Partner with the Network Manager on Split TIN handling and loading for IFP.

- Facilitate monthly affordability calls and agendas. - Monitor opportunity detection tools and support total medical cost savings through provider research, claims analysis, action planning, and outcome monitoring. - Partner with Market Medical Directors and Data Analytics on savings opportunities. - Perform medical benchmarking and network modeling using HPN tools.

- Partner with matrix teams to ensure accurate provider data for filings, including hospital listings and state-specific requirements for the Mid-Atlantic market. - Support recruitment efforts to address network adequacy gaps by validating provider locations, specialties, and viability.

- Represent the market on monthly state-facilitated calls. - Provide regulatory updates to Contracting leadership and the Market Medical Director. - Participate in AHEAD learning activities and support related initiatives.

- Support subject matter expertise related to the No Surprises Act, CMS guidance, and federal and state regulations. - Partner with business owners to ensure workflows and policies are implemented in a timely manner. - Identify operational gaps and recommend process improvements.

- Bachelor's degree or equivalent experience required. - 5+ years of experience in provider network management or healthcare insurance. - Project management experience preferred. - Strong analytical, problem-solving, and critical-thinking skills. - Excellent communication, stakeholder management, and organizational skills. - Healthcare compliance and regulatory experience preferred. - Knowledge of CMS regulations, NSA, and reimbursement structures preferred. - Ability to work independently and manage multiple priorities. - Proficiency in Microsoft Office; Cigna systems experience preferred. - Local market knowledge preferred.

For this position, we anticipate offering an annual salary of 79,700 - 132,800 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.

For more details on our employee benefits programs, click here .

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.