Medicare Advantage Provider Operations Senior Director- Cigna Healthcare - The Cigna Group
Bloomfield, CT
About the Job
* Preferred Office Locations: Nashville, TN, Chicago, IL, Richardson, TX
* Willing to consider Remote/Work from Home for the right candidate.
* Ability to travel up to 25%.
OVERVIEW:
The Medicare Advantage (MA) Provider Operations Senior Director is a senior leadership role within the Cigna Medicare Operations Organization. This role will support the Medicare business (i.e. Individual & EGWP MAPD lines of business by directly overseeing Provider Data Management (i.e. Provider Demographics and Contract Configuration), Provider Directories, Provider Data Accuracy, Network Adequacy, as well as other operational functions. This role will also support matrixed functions, such as Network Operations (i.e. P&Ps, Provider Communications).
To drive to the experience and outcomes that Cigna Government desires for its customers and key provider partners, it is imperative that the underlying data that drives operational outcomes is current and accurate. The primary responsibilities of this role is to direct strategic and operational activities associated with managing and maintaining provider data and configuration changes for our regulated business (Medicare Advantage, , etc.), to work with matrix partners to improve provider data quality where changes primarily occur (i.e. Cigna’s Government Business markets), and to ensure that the front-end processes for installing provider data, configuring new benefits and benefits changes, and testing configuration changes are aligned with and support downstream operational objectives such as improved rates of auto-adjudication. This role will require the candidate to engage and motivate a large team of people with diverse skills, responsibilities and geographic locations, and to drive collaboration with matrix partners (e.g. Product Development, IT, Compliance, Market Leads, Network Operations) to understand and deliver upon our commitments to our beneficiaries, providers, CMS, and State Agencies.
RESPONSIBILITIES:
+ Strengthen and manage connections within the Provider Operations team and with key matrix partners including Product Development, Information Technology, Compliance, Market Leadership and Network Operations.
+ Direct the MA Provider Operations activities for US Government ensuring compliance with organization and regulatory policies.
+ Improve quality such that the MA Provider Operations team consistently meets or exceeds goals for accuracy, timeliness, and regulatory compliance for all department functions.
+ Ensure that the MA Provider Ops team meets all deliverables and milestones supporting the Annual Readiness process for Medicare and Medicaid.
+ Review MA Provider Operations systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals.
+ Review upstream and downstream systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals and to improve customer and provider experiences.
+ Understand and share business controls and information across US Government; ensure that there is clear understanding and ownership of key scorecard measurements as well as of total quality measures and initiatives.
+ Evaluate marketplace opportunities to improve our effectiveness (Cost and Quality).
+ Utilize information technology tools and techniques for organizing, analyzing and interpreting data to solve specific issues with an initial focus on quality and cost.
+ Build understanding and awareness of product strategies and assess operational impact readiness to support as applicable.
+ Implement methods to better utilize customer and provider data to measure our level of success and identify improvement opportunities.
+ Develop a team of people that can lead the organization into the future, supply future leaders to other parts of the organization, and think differently about how we do business.
+ Enable a virtual work environment where managers and employees have the tools, resources, and information necessary for teamwork, productivity and engagement.
+ Ownership of specific workstreams of the DMOM program including but not limited to: the migration of provider demographics for claims payment and development of the provider operating model.
+ Define new standards of operating within the new platforms (Symplyr, Availity and Facets) being deployed for MA Provider Ops with key results and outcomes aligned to organizational objectives and key results (OKRs).
REQUIRED SKILLS:
+ BA/BS in Business or related field preferred.
+ 8+ years of large-scale/high volume operations management within the Medicare/Medicaid industry experience required.
+ Strong knowledge of Network Operations, Claim Operations, and benefit configuration/testing preferred.
+ A minimum 5 years of prior direct people management experience with demonstrated results in leading and developing a team of people required. Experience managing a team of managers and virtual management experience strongly preferred.
+ Innovative, strategic and creative thinking skills with a focus on continuous process improvement is required.
+ Highly collaborative individual with the ability to drive change and influence within a cross-functional matrix team environment. Strong communication skills; written, oral and listening skills.
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.
For this position, we anticipate offering an annual salary of 177,900 - 296,500 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 and long term incentive plan.
We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
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.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
* Willing to consider Remote/Work from Home for the right candidate.
* Ability to travel up to 25%.
OVERVIEW:
The Medicare Advantage (MA) Provider Operations Senior Director is a senior leadership role within the Cigna Medicare Operations Organization. This role will support the Medicare business (i.e. Individual & EGWP MAPD lines of business by directly overseeing Provider Data Management (i.e. Provider Demographics and Contract Configuration), Provider Directories, Provider Data Accuracy, Network Adequacy, as well as other operational functions. This role will also support matrixed functions, such as Network Operations (i.e. P&Ps, Provider Communications).
To drive to the experience and outcomes that Cigna Government desires for its customers and key provider partners, it is imperative that the underlying data that drives operational outcomes is current and accurate. The primary responsibilities of this role is to direct strategic and operational activities associated with managing and maintaining provider data and configuration changes for our regulated business (Medicare Advantage, , etc.), to work with matrix partners to improve provider data quality where changes primarily occur (i.e. Cigna’s Government Business markets), and to ensure that the front-end processes for installing provider data, configuring new benefits and benefits changes, and testing configuration changes are aligned with and support downstream operational objectives such as improved rates of auto-adjudication. This role will require the candidate to engage and motivate a large team of people with diverse skills, responsibilities and geographic locations, and to drive collaboration with matrix partners (e.g. Product Development, IT, Compliance, Market Leads, Network Operations) to understand and deliver upon our commitments to our beneficiaries, providers, CMS, and State Agencies.
RESPONSIBILITIES:
+ Strengthen and manage connections within the Provider Operations team and with key matrix partners including Product Development, Information Technology, Compliance, Market Leadership and Network Operations.
+ Direct the MA Provider Operations activities for US Government ensuring compliance with organization and regulatory policies.
+ Improve quality such that the MA Provider Operations team consistently meets or exceeds goals for accuracy, timeliness, and regulatory compliance for all department functions.
+ Ensure that the MA Provider Ops team meets all deliverables and milestones supporting the Annual Readiness process for Medicare and Medicaid.
+ Review MA Provider Operations systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals.
+ Review upstream and downstream systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals and to improve customer and provider experiences.
+ Understand and share business controls and information across US Government; ensure that there is clear understanding and ownership of key scorecard measurements as well as of total quality measures and initiatives.
+ Evaluate marketplace opportunities to improve our effectiveness (Cost and Quality).
+ Utilize information technology tools and techniques for organizing, analyzing and interpreting data to solve specific issues with an initial focus on quality and cost.
+ Build understanding and awareness of product strategies and assess operational impact readiness to support as applicable.
+ Implement methods to better utilize customer and provider data to measure our level of success and identify improvement opportunities.
+ Develop a team of people that can lead the organization into the future, supply future leaders to other parts of the organization, and think differently about how we do business.
+ Enable a virtual work environment where managers and employees have the tools, resources, and information necessary for teamwork, productivity and engagement.
+ Ownership of specific workstreams of the DMOM program including but not limited to: the migration of provider demographics for claims payment and development of the provider operating model.
+ Define new standards of operating within the new platforms (Symplyr, Availity and Facets) being deployed for MA Provider Ops with key results and outcomes aligned to organizational objectives and key results (OKRs).
REQUIRED SKILLS:
+ BA/BS in Business or related field preferred.
+ 8+ years of large-scale/high volume operations management within the Medicare/Medicaid industry experience required.
+ Strong knowledge of Network Operations, Claim Operations, and benefit configuration/testing preferred.
+ A minimum 5 years of prior direct people management experience with demonstrated results in leading and developing a team of people required. Experience managing a team of managers and virtual management experience strongly preferred.
+ Innovative, strategic and creative thinking skills with a focus on continuous process improvement is required.
+ Highly collaborative individual with the ability to drive change and influence within a cross-functional matrix team environment. Strong communication skills; written, oral and listening skills.
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.
For this position, we anticipate offering an annual salary of 177,900 - 296,500 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 and long term incentive plan.
We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
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.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Source : The Cigna Group