Prospective Program Solutions & Performance Regional Advisor (Market Operations) - Northeast Region - Cigna Healthcare - Hybrid - CAM Industrial Solutions

This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region serving as a liaison between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams.

The Prospective Program Solutions & Performance Advisor works with aligned region supporting prospective risk adjustment initiatives and programs aimed at improving the accuracy and completeness of risk adjustment, advising the market on risk adjustment strategy based on knowledge of Cigna MA's overall Risk Adjustment programs, with a strong focus on alternate prospective programs and bi-directional data exchange initiatives, and overseeing regional and market program performance. This work includes support in initial provider engagement on prospective programs, bridge to implementation, continual workflow optimization and successful prospective program participation. The expectation will be solutioning for short term and longer team participation in Cigna RA programs.

The role will work under the direction of the Senior Manager - National Lead Provider Education to reach overall operational market goals in conjunction with market Provider Performance Enablement teams and the Risk Adjustment Operations team. The role requires expertise in areas that include performance management/analytics, data exchanges, electronic medical record systems, provider workflow and processes, health information management, risk adjustment operations (particularly on the prospective side), value-based care, ICD-10, CPT and HCPCS coding principles and guidelines, and population health management.

Incumbent candidate must be able to work a hybrid schedule and report to one of the following office locations as needed:

• Philadelphia, PA
• Morris Plains, NJ
• Morristown, NJ
• New York City
• Chicago, IL
• Independence, OH
• Westerville, OH
• Pittsburgh, PA

Core Responsibilities:

• Responsible for understanding provider workflow and current processes in place to support risk adjustment accuracy and completeness for Cigna MA and working with market/PPE teams and provider group to ensure effective and compliant process in place to address gaps in care for Cigna customers.

• Serve as liaison to share updates with markets/PPE team on risk adjustment programs and strategy. Serves as strategic advisor for market specific prospective risk adjustment strategy and solutions. Communicates RA program status updates on aligned work to leadership and key stakeholders.

• Provide regular updates on market and regional level risk adjustment metrics and prospective program performance, which includes identifying areas to improve RA accuracy and completeness and working with markets to build solutions and plans to address.

• Identification and support resolution for issues related to participation in market specific RA needs.

• Responsible for working with matrix partners and in conjunction with provider groups to identify modality for prospective program participation, gathering requirements, creating project implementation plans and timelines for successful program launch. Ensures guidelines that require structured data elements and/or mapping in electronic medical records are communicated to matrix partner teams. This would also include tracking to confirm timely completion.

• Coordinate with the aligned Provider Education team supporting market as documentation needs identified.

• Function as a Risk Adjustment and Quality SME to support engagement with market and matrix partners and supports in a consultative way to solution for barriers identified impacting participation with Cigna RA prospective programs.

• Provide visibility and accountability of where providers stand in the process and work of standing up alternative prospective programs. Serves as a bridge with market teams and risk adjustment for implementation discussions.

• Support provider facing RA expertise for national global groups - in conjunction with national contracting partners. This work includes establishing RA focused meetings, attendance/presentation in national JOC's to supporting RA goals/initiatives.

• Responsible for identifying and influencing adoption of processes to improve the accuracy and completeness of risk adjustment in the aligned markets.

• May attend risk adjustment and quality provider meetings as needed to support key functions of role (may occur before/after normal business hours).

• Maintain current knowledge of industry standards, coding guidelines and relevant federal regulations. Utilize Cigna and industry standards tools and techniques to effectively advise market partners according to departmental procedures.

• Maintain compliance in all aspects of work.

• Maintain CEU credits to ensure individual credentials remain up to date.

• May support multiple regions with time sensitive projects when needed.

• Support additional Risk Adjustment and ad-hoc projects as assigned.

Requirements:

• 7+ years of aligned experience with large provider groups and/or health systems in the area of risk adjustment with integration of tools for RA data capture supporting accurate and complete documentation.
• Documentation Integrity, Coding or Health Information Management Certification through AHIMA, AAPC or ACDIS preferred.
• Experience in key areas of healthcare payer or provider operations, CMS Risk Adjustment and HCC coding process and quality including Medicare Star Ratings and HEDIS
• Strongly preferred experience with EMR implementations, complex data platforms, and bidirectional data feeds.
• Exceptional time management skills, ability to multitask and prioritize.
• Effective communication and facilitation skills as demonstrated by prior experience with all levels of the organization, including the ability to solve complex issues, build consensus with stakeholders while demonstrating subject matter expertise.
• Demonstrated experience in initiating, tracking, and managing business initiatives/programs.
• Demonstrated ability to identify and track measurements to determine and support optimal operational outcome.
• Ability to successfully work and navigate with competing projects and multiple deadlines.
• Strong critical thinking skills: demonstrated ability to think about business opportunities in new ways and the ability to understand and clarify barriers to identify resolution/solution,
• Proficient computer skills (with a strong focus on excel)
• Role may require travel that includes local and out of state (requiring airline and overnights).
• Capacity to attend meetings day/evening/weekends as needed within assigned areas. These meetings may be virtual or in person as defined by manager/leadership.

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 72,400 - 120,600 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.

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.