Provider Network Operations Advisor

Role Overview

• Support the management and implementation of provider, hospital, and ancillary networks by researching and resolving provider data issues.
• 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.
• Create, manage, and maintain Market Guidebooks, including rate updates, provider inclusion/exclusion, and audit documentation.
• 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.
• 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 matrix teams to ensure accurate provider data for filings, including hospital listings and state-specific requirements.

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.

Tech Stack

• Cognos

Benefits

• Health insurance
• Flexible work arrangements