Provider Network Operations Advisor
The Cigna Group
full-time
Posted on:
Location Type: Hybrid
Location: Richmond • Virginia • United States
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Tech Stack
About the role
- Support the management and implementation of provider, hospital, and ancillary networks by researching and resolving provider data issues.
- 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.
- Create, manage, and maintain Market Guidebooks, including rate updates, provider inclusion/exclusion, and audit documentation.
- 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.
- 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 matrix teams to ensure accurate provider data for filings, including hospital listings and state-specific requirements.
Requirements
- 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.
Benefits
- Health insurance
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider network managementhealthcare insuranceproject managementanalytical skillsproblem-solving skillscritical-thinking skillsdata accuracyrate and fee schedule auditsCigna systemsCMS regulations
Soft Skills
communication skillsstakeholder managementorganizational skillsindependent workability to manage multiple priorities