Medicare Advantage Provider Operations Senior Director- Cigna Healthcare

* 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-