Provider Network Operations Advisor Job at The Cigna Group (Richmond)

Job Description

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.

Job Responsibility

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

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

Nice to have

Project management experience
Healthcare compliance and regulatory experience
Knowledge of CMS regulations, NSA, and reimbursement structures
Cigna systems experience
Local market knowledge

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Provider Network Operations Advisor

Job Description

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