Provider Network Operations Advisor - Cigna Healthcare - Hybrid

Cigna Healthcare•McLean, VA

1d•Hybrid

About The Position

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.

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.
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 10Mbps download/5Mbps upload.

Responsibilities

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.