Provider Network Operations Advisor - Cigna Healthcare - Hybrid

Join our team as a  
** Provider Network Operations Advisor** , playing a key role in creating and maintaining provider networks that deliver quality, affordability, and access to care. This role shapes provider network strategy across a matrixed group of partners, using data to drive initiatives that support Cigna Enterprise goals and directly impact our clients and customers.

** Key Responsibilities*
* ** Provider Data Resolution*
* + 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.

** Market Guidebooks*
* + 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.

** Alternative Access Network (AAN)*
* + 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.

** Affordability*
* + 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.

** Compliance - Network Adequacy & State Filings*
* + 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.

** HSCRC - State of Maryland*
* + 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.

** Regulatory Compliance - Mid-Atlantic*
* + 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.

** Qualifications*
* + 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.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10

Mbps download/5

Mbps upload.

For this position, we anticipate offering an annual salary of 79, 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,  () .

** About Cigna Healthcare*
* Cigna Healthcare, a division of The Cigna Group, is an advocate for better…